Patricia Hewitt: The future of acute hospital services increasingly lies in high quality, independently regulated and locally accountable NHS foundation trusts, such as Frimley Park in the hon. Gentleman's constituency.

Desmond Swayne: Given that the Government's own commissioner, Professor Sir Aynsley-Green, has said that children who go into adult wards for treatment come out in a worse state than when they went in, will she guarantee that the current provisions in the Mental Health Bill that require age-appropriate treatment settings will remain unamended?

James Gray: My constituent, Miss Fiona Gale of Sherston, having been treated in an adult mental health care ward and abused in various ways while she was there, was then discharged against her wishes. Tragically, she committed suicide in front of a train in my constituency shortly afterwards. The coroner agreed that she should have been treated in a separate children's ward and that there should have been a half-way house between the completion of her treatment and her discharge into the community. I welcome what the Minister has said about under-16s; will she also consider what I have said about the provision of a half-way house?

Rosie Winterton: They are wrong because— [ Interruption . ] I am not saying that those girls are not well intentioned, or that we do not want to ensure that the situation improves. At the moment, the number of such bed days—that is, the number of days when a bed in an adult ward is occupied by under-16s and 16 to 17-year-olds—is dropping. We need to ensure that we have more accurate information about that.
	The Lords amendments include the proposal that a child should be seen by a specialist practitioner—in this instance, a CAMHS specialist. If they were on an adult ward, that would be difficult to achieve. In that sense, the problem is a real one because the CAMHS specialist would not be assigned to an adult ward. Were it more appropriate for the care of an individual aged 17 to 18 to place them on an adult ward, they would not have access to the specialist. As I have said, however, there are certain problems with the Lords amendments—

Andrew MacKay: Is the Secretary of State comfortable with the fact that, due to the actions of the Chancellor of the Exchequer, nurses in England are experiencing a staged pay increase, while those in Scotland are having a full pay increase?

Norman Lamb: I acknowledge the increases in pay over the years, which were clearly needed. Nurses are still, however, one of the lowest paid groups of professionals in public service. Does the Secretary of State accept that nurses this year are getting a real-terms cut in pay, and that the impact on morale of the phased increase, combined with the fact that many newly qualified nurses have no job at all, is really damaging the profession? Is she proud of that situation as we approach the 10th anniversary of the Labour Government?

Patricia Hewitt: I am happy to congratulate everybody whose children have recently been born at that hospital, or anywhere else—perhaps I can cover all congratulations at this point. As we discussed earlier, proposals will come forward for improvements and changes in services in various parts of the country, and there will be proper and full consultation on those proposals. It is important to ensure that in the constituency of the hon. Member for South-West Surrey (Mr. Hunt) and everywhere else women and their partners have the proper choice of having a baby at home if that is what they want and it is safe, having a baby at a midwifery-led unit, or having a baby in a hospital, where there would be a consultant-led unit as well as a midwifery team. We will guarantee that choice.

Andrew Miller: Will my hon. Friend the Minister congratulate my primary care trust for getting its books back into balance and, pursuant to his response earlier on community hospitals, will he ensure that the next round of investment takes into account fabulous community institutions such as Ellesmere port hospital, which are especially fabulous for patients such as stroke victims?

Mr. Speaker: It is not the purpose of the points of order system to correct the record. If the hon. Gentleman had read  Hansard, he would have noted that I stopped the hon. Member for Rhondda in his tracks, to put it mildly.

Barbara Keeley: I beg to move,
	That leave be given to bring in a Bill to require health bodies to identify patients who are carers or who have a carer; to require identified carers to be referred to sources of help and support and to make further provision in relation to such arrangements; to make provision in relation to the responsibilities of local authorities and schools for the needs of young carers and their families; and for connected purposes.
	In March 2006, I introduced a Bill with the same aims as the first part of this new one. As I told the House then, 1 million carers in the UK care for more than 50 hours per week. The 2001 census figures show that carers are twice as likely to suffer ill health if they care for 50 or more hours a week. Medical research also suggests increased ill health among those caring for a person suffering from dementia or stroke disease. It is my view that we must intervene to identify and support the most hard-pressed carers, who care for more hours than the hours of any full-time job.
	In my Worsley constituency, the highest level of caring commitment is needed in the two wards with the highest levels of people with stroke and heart disease, and with cancer. While the national average is one in five carers caring for more than 50 hours a week, that rises to one in four in Walkden North ward in my constituency, and to one in three in Little Hulton ward.
	Those carers play a vital role in health and social care. They are key partners in care for the NHS, but their own health is also threatened and there is a need for recognition of carers' health needs. In 1999, the Government gave GPs and primary health care teams a five-point checklist for use with carers in their practice population. The first requirement in the list was that GPs should identify those patients who are carers or who have a carer. Eight years on from the launch of that national strategy, research shows that the work done nationwide by GPs and primary care teams to identify carers in their practice population is still inconsistent. Research by the Princess Royal Trust for Carers concludes that only a small proportion of the total number of carers is being identified. Even GP practices with good links to their local carers' organisations are not doing the work necessary to identify all those carers whose health might be affected by their caring responsibilities.
	Two carers known to Carers UK provide examples of how important it is to identify carers. Valerie Low of Carlisle cares for her husband, who was severely brain damaged in a car accident in 1997. For years, Mrs. Low did not know that advice or respite care were available to help her as a carer. Now that she has been identified, she arranges respite care from Crossroads.
	Tracy Barker from the Isle of Wight has cared for her son for 16 years. He has autism, asthma and epilepsy. Like many parent carers, Ms Barker did not see herself as a carer and had no idea of the support available to help her. She struggled to pay bills, yet she had not been told about carer's allowance. Eventually, she had to move to a different area for financial reasons, and then she suffered depression. Now that she has been identified as a carer, she receives carer's allowance and has attended a number of courses that have helped her.
	If they are not identified, carers will struggle without the help or support that they need. My Bill would require that primary care trusts and local health boards ensure that effective procedures exist within primary care to identify carers, and that carers are referred for advice and given regular health checks.
	The Pensions Bill also requires the identification of those carers caring for 20 or more hours per week so that they can earn the carer's contribution credit. My hon. Friend the Minister for Pensions Reform has made a commitment to use the Government's review and update of the national carers strategy as an opportunity to explore how that identification can be carried out by health and social care professionals. That is a welcome step forward.
	In previous years, hon. Members of all parties have given their support to carers week, which this year runs from 11 to 17 June. Its main objective is to enable new and "hidden" carers to access support and services.
	Young carers are perhaps the most hidden of all carers. The 2001 census records some 175,000 young carers, but only 30,000 of them are known to young carers support services such as the Princess Royal Trust for Carers and other children's charities. Indeed, a survey by NCH and Carers UK showed that fewer than one in five of known young carers have received an assessment of any kind.
	The Princess Royal Trust for Carers believes that it is likely that the most vulnerable young carers, including some of the 13,000 who care for more than 50 hours a week, continue their caring role throughout their childhood without any support. Young carers may have parents with substance misuse or alcohol problems, and the extent of that problem is not fully understood. The "Hidden Harm" report estimated that 250,000 to 350,000 children have parents with serious substance misuse problems. The alcohol harm reduction strategy for England states that between 800,000 and 1.3 million children are affected by parental alcohol problems. In the families of alcoholics or problem drug users, children may find themselves responsible for their parents' safety.
	My Bill would place duties on social services authorities to consider what support services are needed to sustain the parenting role in such families. When a parent is assessed for community care services, support services should be offered if it is found that the adult relies for support on the caring role of his or her child. In that way we can ensure that the health, education and well-being of the child or young person are not impaired by caring responsibilities.
	Young carers may have a parent with an illness such as multiple sclerosis, or with a learning or physical disability. The parent may rely on the care from their child, as a case known to the Princess Royal Trust for Carers illustrates. A single parent was diagnosed with multiple sclerosis and loss of mobility, which affects not only her but her children, aged 8 and 12, who have to provide her with the round-the-clock support she needs.
	Such children are missing out on their education and, like other young carers, they find themselves misunderstood at school, treated as truants and bullied by other children. Schools need written policies stating the support that they will offer young carers. My Bill would require that both schools and local authority children's services have policies in place to support such young carers.
	Many health and social care professionals are frustrated by the difficulties they experience due to different thresholds for service provision for different client groups. An adult mental health worker may be aware of several children affected by their parent's mental health condition. However, unless the children are at risk of serious harm the health professional will probably not be able to help them. The general duties to young carers and their families outlined in my Bill would help. A simple joint working protocol between children's and adult services, combined with a training programme for staff, would help to solve the problem.
	Census figures tell us that a minimum of 2 per cent. of all children in the UK are young carers. However, work by Professor Saul Becker of Nottingham university and others suggests that the true number of young carers could be much higher—possibly 1 million of the 3 million children and young people who live in families where there is serious illness or disability. Whichever figure we use, we need now to bring in measures so that schools and local authorities recognise the issues faced by young carers.
	I have outlined how the measures in my Bill would ensure that health professionals identify carers and refer them to much needed help and support. As we move towards the Government's review of the national strategy for carers, I hope the measures outlined in the Bill will offer a sturdy framework for improved services and support to carers. My Bill is supported by Carers UK, Contact a Family and the Princess Royal Trust for Carers. I thank Carers UK and Luke Clements for helping me to draft the Bill and Alex Fox of the Princess Royal Trust for Carers for his input on young carers. I also thank the House for giving me the opportunity to present it today.
	 Question put and agreed to.
	Bill ordered to be brought in by Barbara Keeley, Tony Baldry, John Bercow, Mr. Paul Burstow, Annette Brooke, Dr. Hywel Francis, Helen Goodman, Lady Hermon, Mrs. Sharon Hodgson, Ms Diana R. Johnson, Ms Sally Keeble and Lynda Waltho.

Andrew Lansley: The hon. Gentleman must know that, in the general election the year before last, we committed ourselves to exactly the same level of funding as applies now. However, we are talking not about the next election, but about what is happening now. We are committed to the same level of funding, but we are also committed to a far more efficient use of that funding.
	The hon. Gentleman could have said, "By the way, the Government spent £72 million on the NHS university", but that turned out to be completely wasted. What is their response to that waste of money? It was to try to suppress the report by Sir William Wells that was designed to examine where all that money had gone. Let us first be concerned with spending money effectively before we start debating how much money there will be beyond the comprehensive spending review.
	The Secretary of State is sometimes at pains to challenge us on whether we agree with the principles behind modernising medical careers. Yes, we agree that modernising medical careers is a necessary process. To put it at its simplest, let us consider whether services in the NHS should be provided in the long run by specialist doctors or by doctors in training. Patients and the public would expect the services to be delivered by specialists and that it would be a consultant-led and increasingly a consultant-delivered service. When one looks across the world, one sees that this country has been unusual in the extent to which services in NHS hospitals, in particular, have been delivered by doctors in training rather by doctors who have their specialist certificates.
	The principle of modernising medical careers is accepted and we also accept many of the principles in the documents of 2002 and 2004 that led to it. We should not rely on doctors in training for service delivery and training must be limited in time. It cannot be open-ended. As Sir Liam Donaldson said in his report about the "lost tribe" of senior houses officers, we cannot have junior doctors who drift from one SHO job to another for years without ever making progress in specialist training.
	Let us remember that one of the principles of MMC was that it was intended to be flexible and widen career choice. Where did that one go in the translation of principles into practice? The way in which MMC has been implemented is lamentable. When people look at the political gravestones of the figures in the Government, they will see carved on them, "It should have worked in principle, but it didn't work in practice." The Government started out with good intentions, but time and again they have failed to deliver. Here is another lamentable and shocking example of how they have failed to turn what, five years ago, was a straightforward set of principles into something that works in practice for those in the NHS today.

Peter Bottomley: I, like Ministers, care about what is happening, but perhaps Opposition Members have been more open about some of the problems. Locally, we have discovered that filling out 150 words is worth the same as a PhD, which involves three years or more of hard work. An explanation of that is needed. On the first day the system opened, it was apparently not possible to apply for a job within 50 miles of Worthing or for one in genito-urinary medicine. The problem is not the computer or the method of consulting the people who put the thing together. The problem was caused because the system was not run as a trial in at least one region to determine the experience. Will my hon. Friend commit us to go on working not only for senior and junior doctors, but for those in the MMC system who resigned because of a loss to confidence, by backing the doctors and, if necessary, saying to the Government, "Why don't you drop your defences and join in working out the problems and solving them?"

Andrew Lansley: My hon. Friend has captured exactly what we are trying to achieve through this debate. If hon. Members read the motion, they will see that its objective is not to engage in the easy task of saying, "It's all gone wrong and the Government are to blame." The motion engages with the question of what needs to happen now, although I note that the Government amendment says nothing at all about that.
	The Government have been given warnings and they have to account for why they did not accurately reflect on the problems. The hon. Member for Broxtowe (Dr. Palmer), who asked the Whips' question and then left the Chamber, said that this is about the number of applicants. However, I remember standing at this Dispatch Box on 20 December 2005 and making it clear to the Secretary of State that there would be a problem in August 2007 because two year cohorts of applicants would be coming together in one year, so the number of applicants for training posts would effectively double. The Secretary of State said that that issue had to be addressed. With a year and a half in hand, I was foolish enough to imagine that she would solve the problem. When, on 13 December 2006, Lord Warner said that junior doctors in England should be pretty confident about securing a training post and that additional training posts would be created, I was foolish enough to think that the Government had considered the situation and arrived at a solution.
	There was a good deal of forewarning. The royal colleges rightly told the Government that the programme should be piloted, as my hon. Friend the Member for Worthing, West suggested, but that did not happen. Last year, junior doctors in the British Medical Association wanted a delay of a year. To be fair, I was not sure that that was the right thing to do because it would have harmed the circumstances of the foundation programme graduates. None the less, the BMA was rightly pointing out serious unresolved problems.

Andrew Lansley: The hon. Gentleman is leading me further into what I was hoping to say. Let me just respond to that point. From what I know of the interviews that are already taking place, many consultants holding the interviews are meeting well qualified applicants; I see that the Secretary of State is nodding merrily. However, unfortunately, we know that many well qualified applicants did not get interviews. As the hon. Member for Oxford, West and Abingdon (Dr. Harris) suggests, we need a process in which well qualified junior doctors have progressive opportunities to enter specialty training, and that is what our motion says. It also suggests that it may not be possible for all well qualified applicants to secure specialty training or run-through training posts this year, but we have to put a stop to the current structure, which, in effect, limits the ability of some people, particularly senior house officers, to enter specialty training next year, or the year after that, if they do not enter the run-through training process this year.

Andrew Lansley: I am grateful to my hon. Friend, who makes an important point. He reminds us of the most important reason why we are debating the subject. I have received hundreds of e-mails on the subject, and I have met many constituents, as I am sure that colleagues from across the House have done, who are concerned for their careers, for their livelihoods, for the fulfilment of their vocation to be a doctor and care for patients, and often for their family life. I ask hon. Members from across the House to imagine how they would feel if they were junior doctors, who are highly motivated professionals who have gone through graduate education, and who have, in some cases, worked in the health service for several years. They are senior professionals by any measure, but the net result of the current structure, including the way in which the review group has changed things, is that there is one interview for one unit of application, and that might be for a post anywhere in the east of England, from Hemel Hempstead to Cromer. That is the sum total of their ability to exercise control over the future of their career.

Andrew Lansley: I am grateful to my hon. Friend, because he further reinforces my point. I have often met married junior doctors who are wrestling with the issue of how they can both secure posts in a way that is consistent with maintaining their family life. That is intensely difficult. My hon. Friend's point is a fair one; the British Medical Association is today warning that literally thousands of junior doctors could end up going overseas. What is the Government's response? Well, we saw the document produced in the Department of Health last week. It was not published, but it found its way out. The Government are "volunteering" junior doctors to join the Voluntary Service Overseas, so that they go abroad.  [ Interruption. ] Well, it struck me that VSO is about volunteering—not the distressed reallocation of doctors from the United Kingdom to overseas, which is outrageous.

Tony Baldry: Further to the point made by our hon. Friend the Member for Buckingham (John Bercow), how do I explain to my constituents at the Horton hospital that we are likely to lose 24/7 consultant-led paediatrics, consultant-led obstetrics and a special care baby unit in the near future, because we have been told that there are insufficient doctors? How is a community like north Oxfordshire to accept on the one hand that there is a substantial downgrading of NHS services in Banbury and the surrounding area in a way that has never taken place before while on they other it can see that junior doctors are being thrown on to the scrapheap?

Andrew Lansley: There is only one way for my hon. Friend to explain that to his constituents: it is chronic mismanagement of the national health service by the Government. It was the Government's intention to continue the expansion of consultant posts, but that has been torpedoed by the mismanagement of finances and deficits in the health service so that across the NHS posts have been frozen, consultant posts have disappeared and specialist consultants in some specialties cannot find posts. The consequence is seen not only in the impact on Horton hospital in my hon. Friend's constituency, but across the country. The increase in medical school output or in the number of junior doctors coming through would have been consistent in due course with a larger throughput into consultant posts, but the Government's attitude is that those consultant posts have been lost for financial reasons and they are cutting back on the hospital sector, so they want to maintain a tight bottleneck at the point at which junior doctors enter the further reaches of specialty training. They are stopping the flow, and they are literally forcing large numbers of doctors to leave the country.
	The Government may believe that the doctors who will leave this country will be those who came from overseas in the first place, but that is not how it is working out. It is an arbitrary system. The scoring system, recruitment and application system have been made "objective" in a way that has become virtually arbitrary. Those who are selecting candidates for posts across the country were unable in the initial process to see anything like sufficient of the clinical experience, the academic achievements and the character of the candidates presented to them. It turned into a scoring system in which someone could literally—and I have evidence in my file—pay £129, go on a course, and be told how to answer the questions to be selected for interview. That is utterly outrageous.

Andrew Lansley: My right hon. Friend may be aware that we are constantly searching for accurate figures as to precisely how many applications and run-through training posts there are. Of the 18,500 posts in England—I think that the Department would acknowledge that figure—we have not even been told how many are run-through training posts and how many are fixed-term posts. The disparity between the figure of 18,500 and anything up to 34,000 posts is principally the result of the combination of two annual cohorts coming together because the new MMC process is shorter than the old training process, the right of European economic area nationals to apply without legal restrictions in this country, and a large number of overseas doctors who, for example, have highly skilled migrant programme visas.
	There is no reason, as far as I am aware, why the Department should not have anticipated all those components. As little as four months ago, the Department, in the guise of the former health Minister, Norman Warner, was about a third out on the number of potential applicants. It is not good enough for Ministers to say, "There were more applicants than we expected so it all went wrong." They were responsible for the process. They are responsible for the number of junior doctors who have access to training in this country. They should have known the likely outcome and dealt with it.
	Time and again we have told Ministers that there would be thousands of junior doctors who are left without training posts. The response of the Secretary of State is always to misinterpret that and say, "You're saying that they are all going to be unemployed, and that's shroud-waving." She said on 19 March that
	"the shroud-waving about unemployed doctors is absurd."—[ Official Report, 19 March 2007; Vol. 458, c. 582.]
	In a letter to me on 27 March she stated:
	"It is wrong to conclude . . . that there is a danger that these doctors will be unemployed"—
	 [Interruption.]
	The Secretary of State says that is right, but in her own Department a document is being circulated, the purpose of which is to try and deal with the fact that up to 10,000 junior doctors will be unemployed. That is what it says—unemployed or without training posts. It was not absurd. We were not shroud-waving. It was a fact and the Government knew it, but they would not admit it.
	The Secretary of State has been in appalling denial about all this. I shall try and avoid a long quote, but I want the House to listen to the words of one consultant who wrote to me describing the process from the interviewer's point of view. We are hearing from junior doctors about how appalling the process has been. The consultant wrote:
	"Today was the first occasion in 20 years that I was asked to make important decisions on the careers of our future colleagues, with no CV or application form to review in preparation for the face-to-face. The only information I received was a list of candidates—in no particular order—and a start time and venue. Each candidate arrived armed with a brief one-page summary, hand-written immediately prior to interview and a portfolio the size of one or two telephone directories. Three colleagues and I were supposed to review these in 30 minutes flat, at the same time as we conducted a structured interview, marked each domain individually, and finally came to an agreed score for each domain that will be forwarded to MTAS . . . I never saw any references and there was no opportunity to review our decisions. This process is the antithesis of fair employment and equal opportunities."
	That is from the consultant's point of view. Imagine how it seems from a junior doctor's point of view. I have a quote from a junior doctor who describes his experience. He states:
	"I have a first-class degree in medicine/neuroscience, medical degrees with distinction, two research doctorates . . . in behavioural neuroscience, nearly 30 scientific publications including text books and commercialized research software, research prizes, three years' experience as a lecturer in neuroscience at the University of Cambridge, and two years' experience as a medical SHO at teaching hospitals . . . whilst I was short-listed for an ST2 medical position I failed to be shortlisted for ST1 psychiatry, which requires no previous psychiatry experience. Presumably, in some way my answers to the 'anecdote' questions didn't fit the psychiatry scoring system, whatever that was".
	That reflects precisely the point made by my hon. Friend the Member for Worthing, West. A candidate can end up with all those qualifications but fail to be shortlisted because of the scoring system, under which a PhD was worth one point and 150 words on how one copes with stress was worth four points.

Andrew Lansley: I am grateful to my hon. Friend. I am sure that the Secretary of State heard what he said, and I hope she will respond. On interviews, I suspect that she is not looking forward to the one with the next Prime Minister.
	The Secretary of State has been in denial. She has told the House about the outcome of the review group. In a letter to me on 27 March she stated:
	"The Review Group is independent and responsibility for membership rests with Professor Neil Douglas".
	But a freedom of information request to the Department secured the answer:
	"I can confirm that Clare Chapman, Director General of Workforce at the Department of Health, had overall responsibility for considering who was appropriate to sit on the review group."
	It was not independent at all. It is no wonder, given the lack of a strategic solution from the review group led by Professor Douglas, that the Secretary of State has had to announce a new and a second review.
	Professor Crockard, who was responsible for the modernising medical careers process, resigned, and in a letter to Liam Donaldson, the chief medical officer, said:
	"I have become increasingly concerned that the well intentioned attempts to keep the recruitment and selection process running have been accompanied by mixed messages for the most important people in the whole process—the young doctor applicants."
	It is basically unfair to advertise the possibility of four interviews and then suggest that these might not be honoured. Shelley Heard, the clinical medical adviser to the MMC process, said:
	"The Review Group has not done this strategically or with an eye to the future."
	This is why we are here this afternoon. The Secretary of State and the Government are in denial about the scale of the process or the many difficulties and problems with the scoring system and the recruitment process, which I have not had time to go through, and are not coming forward with viable solutions for the future.

Patricia Hewitt: I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:
	"recognises the international reputation for excellence of medical training in the UK; acknowledges the need to modernise medical careers to ensure all doctors are properly trained to nationally recognised standards, including a fairer and more transparent process for applying for specialist training; notes that Modernising Medical Careers (MMC) will deliver training to a consistently high standard which, combined with the expansion of the number of doctors, will provide high quality safe care by appropriate skilled medical staff; notes the wide consultation that took place on MMC and the strong support for the need to improve doctors' training amongst doctors' representatives including the medical royal colleges and the British Medical Association; welcomes the external review that is already being conducted into how MMC has worked to date and the changes made as a result; and supports the longer term review recently announced to ensure MMC works well in the future."
	Let me begin by stressing, as I did last week, that my ministerial colleagues and I are in no doubt about the distress, anxiety and uncertainty that has been caused to junior doctors by the problems with this year's applications system. Those problems should not have arisen, but they have, and we are all—Ministers, officials in the Department, the medical royal colleges, the British Medical Association, the post-graduate deaneries—completely focused on sorting them out so that, as I said to the House last week, we have a system for this year that is fair to junior doctors and enables the NHS to make the right appointments to all the posts involved.
	In addition to the urgent questions that the hon. Member for South Cambridgeshire (Mr. Lansley) mentioned, there have already been three written ministerial statements as well as last week's oral statement. I will, of course, continue to update the House on the work of the review group under the leadership of Professor Neil Douglas, which will remain in existence while we continue to sort out the problems that have arisen with this year's applications system.
	Before I return to the question of the applications system and look forward to Sir John Tooke's review, I want to say a little more about the new medical training system and what it replaces. As on previous occasions, the hon. Gentleman has simply understated the very real problems of the old system that modernising medical careers replaces. That system, as the whole House would acknowledge, has always produced outstanding doctors for the NHS, many of them world leaders.
	However, that system was also wasteful, inconsistent, often unfair and, indeed, as the Royal College of Surgeons said several years ago, "most unsatisfactory". Some junior doctors had to apply for a new training post every six months. They were sending in different applications in different formats to different hospitals and different post-graduate deaneries at different times of the year. There was no proper national curriculum and no standardised assessment process. It has always been the case that, because of the intense competition for medical training posts, junior doctors who could not secure the senior house officer job that they wanted found themselves filling in time in the wrong post—from the point of view of the skills that they wanted to develop—in non-training posts or as a locum. Sometimes, as Conservative Members pointed out, they had to do so for years on end.
	Remedy UK, the newly formed group that has been so critical—and understandably so—of this year's problems says in its briefing paper on MMC that many of those in the old senior house officer job were in short-term or non-training posts or endured poorly planned training with no clearly defined end-points. There were certainly deficiencies in the selection and appointment procedures, along with inadequate supervision, assessment and career advice. It was precisely because of those problems that, following the leadership of the chief medical officer, the Department of Health sat down with the medical royal colleges, with the British Medical Association, with the post-graduate deaneries and others—including, of course, representatives of the junior doctors—to devise modernising medical careers, which almost everybody agrees is the right way forward. Indeed, Professor Douglas's review group has confirmed that.

Patricia Hewitt: What I accept in response to the hon. Gentleman's question is that it has never been possible for every junior doctor who wants to pursue training through to a consultant post to be able to do so, particularly in the specialty that they originally wanted to follow. I will come back to that point in a moment.

Patricia Hewitt: I want to make a little more progress before I give way again.
	The first part of the new system—the two-year foundation programme—was successfully introduced in 2005. In line with the principles that will operate throughout modernising medical careers, that will give every medical graduate a series of properly supervised placements in medicine, surgery and a range of other specialties and settings, with formal training based on a national curriculum developed following wide consultation with the profession, including the medical royal colleges, and approved by the Postgraduate Medical Education Board. It will also provide our medical graduates with regular workplace-based assessments of competence, a national learning portfolio and formal access to careers advice, all of which were missing from the old system.

Nadine Dorries: As my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) has said, there is no argument about the fact that doctors' careers and training processes needed modernising. The issue is that it has been a complete, unmitigated disaster, yet the Secretary of State is not accepting responsibility for that.

Patricia Hewitt: First, in response to my right hon. Friend the Member for Birkenhead (Mr. Field) and other questions, I want to clarify the total number of training places available: about 23,000 postgraduate medical training appointments are available across the UK this year, which is more than ever before. Of those, 3,000 are being filled by recruitment to general practice, and just over 19,000 places are available on MTAS at the moment, with a further 700 to be added to the system. We all know very well that there are more applicants than training posts. That has always been the case, but it does not mean, as headlines and some press reports claimed at the weekend, that there will be 10,000 unemployed doctors.
	Of the 32,000 or so eligible applicants for those training posts, about 30,000 are already working in the NHS, about 6,000 of whom are completing their foundation programme, and about 8,000 of whom state on their applications that they are working in non-training posts—trust jobs, staff jobs, locum posts and so on. About 16,000 say that they are working as senior house officers, but because of the deficiencies in the present system, many of those posts are not proper training posts either. Regardless of the outcome of applications for the new training posts, the NHS will continue to need all those jobs and possibly more in the future, because the number of patients is increasing, and so is the number of doctors—the NHS now has over 30,000 more doctors than 10 years ago.
	Someone who is currently working in the NHS in a non-training post, whatever it is called, who does not get the training post for which they applied this year, will be disappointed, just as many were last year, the year before and every other previous year. They will still, however, have their job. Those who do succeed in getting a training post will leave a vacancy that can be filled by a doctor—with appropriate experience, of course—who has failed to get the training post that they sought this year.

Patricia Hewitt: I want to make a little more progress before I give way again.
	I fully recognise that it would be quite wrong to leave a junior doctor part-way through his or her training with no clear prospects. Until the whole process of interviewing and job placement is completed in a few months time, we will not know which trainees—whether they are just completing the foundation programme or are more senior—have obtained specialist training posts. However, I assure my hon. Friend and the House that we will give them proper support.
	As part of the review, we are working urgently with the royal medical colleges and the NHS to establish the need for additional training posts—which will of course have to be approved by PMETB—including one-year placements and more senior posts. We are also considering how we can provide more effective training support for doctors in service posts—that is, non-training posts—to maximise their development opportunities. That is the issue on which Professor Douglas's review group is now focusing, having dealt with earlier problems involving the application process, and it will make a full statement—as will I, to the House—on the support that will be available very shortly.

John Bercow: The right hon. Lady referred to the needs of patients. When we envisage circumstances in which every junior doctor in every grade and in every specialty changes job on the same day, the spectre is inevitably raised—and it was articulated to me only this morning—of wards either empty or massively understaffed, potentially thereby—I choose my words carefully—imperilling public and patient safety. The right hon. Lady shakes her head, and she is entitled to do so, but can she assure me that there will be no such scenario anywhere in the country? If she is confident that she can, will she say precisely what contingency planning is being made to enable her confidently to make that prediction?

Patricia Hewitt: As I have just said, the great majority of applicants who are already in non-training staff posts, trust posts and a variety of other non-training posts will still have those jobs because they will still be needed in the NHS. Each hospital trust, and the board of each trust, has a responsibility to its patients to ensure that on 1 August, or any other day, the right number of the right staff are available to provide safe, high quality care.

David Heath: It is instructive that the right hon. Lady chose the small specialty of cardiothoracic work, which has always been oversubscribed, and it would be interesting to find out whether she can give any other such examples. However, may I return her to a question that she has still not addressed, despite having been asked it at least three times this afternoon? There was an entirely predictable consequence of the double cohort. What planning did the Department make to deal with the double cohort issue?

Patricia Hewitt: The hon. Gentleman is ignoring that, because of how the old system worked—with junior doctors applying for jobs all over the country, and with different application systems and things happening at different times of the year—there was no national system. Therefore, we had no numbers in respect of the amount of people who had been applying unsuccessfully for training posts. I agree that it is clear, with the benefit of hindsight, that it would have been better if we had predicted that almost everybody in a non-training post would take the opportunity of this year—which is the first year of a system that is much fairer and much more transparent and that has more training posts available than ever before—to make an application. Of course it would have been better if we had predicted that. We failed to do so, and I have apologised for the problems and distress that that has caused. More importantly, however, we are now putting that right.

Andrew Pelling: I am grateful to the Secretary of State for giving way. What would her advice be to the four junior doctors from my constituency who visited me today, all of whom have been offered training posts in Brisbane, Toronto and Singapore, bearing in mind that the offer being made by the Secretary of State is that they can have some kind of job in the NHS, even perhaps as a rural GP in Scotland—an example of "Dr. Finlay's Casebook", if ever there was such an example? Would her advice be that it would be best if, despite the £250,000 that has been spent on the training of each of them, they accept those job offers outside the United Kingdom?

Patricia Hewitt: I am unsure whether the hon. Gentleman is prejudiced against general practitioners, or those working in country areas, or those working in Scotland. The job he mentions is in my view an excellent post, and I am sure that someone will fill it admirably. He also ignores the fact that 23,000 postgraduate medical training places will be available across the whole of the United Kingdom, which is more than ever before.
	Let me deal with the issue of doctors going abroad, which the hon. Member for Croydon, Central (Mr. Pelling) just raised. At the weekend, there was some quite disgraceful reporting in some sections of the press. On the one hand, they were busy saying how disgraceful it is that doctors have had to suffer the distress and added uncertainty of this year's difficulties, while on the other they ran a headline saying that they are all going to be shipped abroad to do voluntary service overseas. That is absolute rubbish. It has always been the case that some British junior doctors have chosen to go abroad at some stage in their training to get extra experience to further that training. Some do voluntary work in, or are on secondment in, the developing world—an issue on which the noble Lord Crisp recently produced an excellent report. However, there is no question of junior doctors being forced into those options or being shipped abroad.
	We all need to focus on the interviews that are taking place and that will continue over the coming month, the first round of job offers that will then be made, and the enormous effort that will go in—thanks to the work not just of the review group, but of consultants and the postgraduate deaneries around the country—to matching, as far as is possible, junior doctors with their first preference application, and to match, wherever possible, medical couples with their combined preferences through the medical training application system, which is an issue that was specifically raised. Of course, there will then be a second round of interviews and job offers. Once all that has been done, we will then ensure proper support, as I indicated a moment ago, for those trainee doctors who have not secured the training post that they wanted.

Frank Field: I am very grateful for the chance to make a second intervention. I ask my right hon. Friend not to answer the Liberal Democrats' endless plea for a post mortem.  [Interruption.] Yes, the Liberal Democrats did ask for a post mortem to find out what went wrong. We all know that something has gone wrong—even the Liberal Democrats should understand that simple point—however, young doctors in Birkenhead want to focus on the future. In answer to my previous intervention, my right hon. Friend said that, at some stage, she and others would consider the creation of new training posts. Will she please say a word or two about that before the end of the debate?

Norman Lamb: I take that point. When the professor says that there is a lack of leadership from the top, we need to know whether he is referring to the Secretary of State, or a civil servant —[ Interruption. ] MTAS is a Department of Health initiative, so we need to know from the Minister to whom Alan Crockford—[Hon. Members: "Crockard."] We need to know to whom Alan Crockard refers when he says that there is a lack of leadership from the top. Will the Secretary of State publish all the correspondence as part of a wider review so that lessons can be learned about what has gone wrong?
	Will the Secretary of State publish any written submissions made by Professor Shelley Heard, who has also resigned? Professor Heard was the national clinical adviser and has been quoted as saying that the principles
	"have been lost in the detail and acrimony of a recruitment process which should have supported and not driven it".
	She said:
	"we are losing the goodwill of a generation of UK graduates who believed it when we said we wanted to train more UK doctors better and we are losing the goodwill of patients and senior colleagues".
	Professor Heard also fundamentally challenged the direction taken by the review group set up by the Secretary of State. She said that the group
	"has become so immersed in the detail that it cannot see a way ahead which will be both equitable to doctors and support the aims of MMC".
	She found herself
	"able to support few of the decisions that the review group has taken since they undermine the principles which are at the core of MMC".
	Does the Minister accept that the review group's direction of travel is undermining the principles at the core of MMC, as Shelley Heard suggests? That is a serious challenge to the direction that the Government are taking.
	I am an employment lawyer by training, and before I became a Member of Parliament I advised employers on fair recruitment processes fairly regularly. This is not a fair recruitment process. It is fatally flawed, and once a process is flawed, one cannot satisfactorily remedy it. Will the Minister confirm whether the additional interviews for those candidates not hitherto given interviews will be conducted by differently constituted panels? However objective a scoring system, once different assessors are introduced on to a panel, objectivity is destroyed. Once something is flawed, it is always flawed, and that is why I have supported the attempts by Remedy UK to secure a judicial review of the process.
	I want to explore the recovery process itself. I understand that all the additional interviews will take place over a four-week period in May. Will the Minister confirm how many extra interviews the Government expect will be required? Will that be logistically possible to achieve? When I put that question to the Secretary of State last week, she said that it would be achievable, but "only with considerable effort". That suggests that there is a risk of substantial disruption to patient services and a possible impact on patients.
	I understand that trusts are resistant to allowing consultants time off their clinical work to conduct the interviews. The hospital trusts are all under intense pressure to deliver on waiting time targets, yet they will lose a substantial number of clinical hours to conduct additional interviews. I understand that 10 candidates were originally interviewed for two specialty training level 3—ST3—posts in cardiac surgery in London, but that it is expected that an additional 50 applicants will be interviewed to comply with the review group's new process. Will the targets with which acute hospitals must comply be adjusted to take account of the disruption that will inevitably occur, given that if a surgeon is interviewing, he or she is not operating? A question was raised about the cost of the recovery programme, and I hope that the Minister will give a confirmation of its cost.
	What analysis has been undertaken of the impact of all junior doctors starting their new roles on 1 August? The Secretary of State, who I notice has disappeared from the Chamber, indicated that the turnaround has always taken place on 1 August, but I understand from my hon. Friend the Member for Oxford, West and Abingdon (Dr. Harris) and many others that that is not the case. It was a phased process; all junior doctors across the country did not change jobs on one day. It is hard to imagine a more crass arrangement than one in which everyone is expected to start work under a new system at exactly the same time. Induction procedures will take doctors away from their duties, and I understand that many hospitals will, in effect, operate bank holiday working arrangements during that period, cancelling operations and clinics. Newly appointed doctors will find that their predecessors have already gone, leaving inadequate knowledge of the patients on the wards for whom the new doctors are supposed to be caring.
	I suppose that it was inevitable that the changeover for the whole country would be planned for a peak holiday time, when so many consultants are away. That simply adds to the challenge. I have heard that some trusts are starting to suspend the right of consultants to go on holiday in the first two weeks of August. That suggests that acute trusts are anxious about the potential impact on patient care during that period.
	On the mismatch between the number of applicants and the number of posts advertised, the Secretary of State indicated that there were about 23,000 training posts, but of those 23,000, she said that 3,000 are general practitioner posts. She then said that the net figure for hospital posts was something over 19,000. I do not quite understand the maths, but that is what she said. She also said that 700 extra posts were being added. I do not understand where that figure comes from, and I would be grateful if the Minister of State could explain when he winds up the debate. Are those 700 extra posts the additional training jobs that the Government said that they hoped to provide, or are we expecting more training posts on top of that 700? The people affected by the problem, many of whom are in the Gallery today, deserve clarity and answers from the Government on that point.
	The Secretary of State was right to point out that some, but not all, of the people who do not get training jobs will continue in their existing posts. Will the Minister give his assessment of the number of junior doctors who are likely to be unemployed come the summer? The hon. Member for Wolverhampton, South-West had a stab at providing a figure, but he was told by the Secretary of State that he had overstated the numbers because many people would remain in their jobs, so what is the figure? We know from the document leaked last week that Government planning is proceeding on the basis that thousands may be unemployed. It is incumbent on the Government to tell us the estimated number of junior doctors who will be unemployed this summer.
	The document referred to the possibility of junior doctors being sent off with Voluntary Service Overseas. VSO is a fantastic concept and I applaud all the junior doctors and the many other professionals who do voluntary work overseas, but as a human resources solution for a Government who have got themselves into a hole, it is hardly an appropriate way forward. Will the Government publish the document that was leaked last week? I have not seen it. Is it available, and may we see what the Government are planning to do with all the unemployed doctors this summer?
	We are told that it costs about £250,000 to train a junior hospital doctor. How many are likely to end up heading overseas or leaving the profession as a result of the crisis? What is the scale of the resources that will be wasted on all that training?
	The hon. Member for Wolverhampton, South-West raised the issue of the two cohorts coming together, as did my hon. Friend the Member for Somerton and Frome (Mr. Heath) in an intervention on the Secretary of State. We still have not had a satisfactory answer on why the Government did not expect that to happen and why they do not appear to have planned for it or its consequences.
	I suspect that the right hon. Member for Birkenhead might disagree on this point, but one sensitive, but important, issue is the way in which we treat foreign doctors who work in hospitals across the country, many of whom have given dedicated service to the NHS. How will they be treated as a result of this debacle? My hon. Friend the Member for Oxford, West and Abingdon made the point that, historically, staff grades that are often filled by ethnic minorities and women are, in a sense, dead-end jobs, with no prospect of career advancement. Why can the Government not plan to convert those jobs into training posts, to give the occupants the chance of career enhancements?

Evan Harris: Does the Minister accept that the key to the mismatch between the number of juniors looking for training posts and the number of training posts available is the question of consultant expansion? It begins and ends with that, because what patients want—we must remember patients—is a consultant-provided service. The Minister must explain whether medical schools were expanded in order to fill an expanded consultant grade, or whether they were expanded in order to fill trust-grades, clinical fellowships and staff-grades—all non-training posts, which many people do not want to occupy even though they are in such posts? Does he expect that the consultant expansion we need will take place? In 1997, a  British Medical Journal editorial noted that "consultant expansion was insufficient." That editorial was written by a Dr. Evan Harris, but 10 years on, I see that there is still no expansion—

Norman Lamb: I have a great deal of sympathy with the right hon. Gentleman's intervention. We heard earlier that the departing director said that the system had been mismanaged and that there had been a lack of direction "from the top". Where is the top? Is it Ministers? The Secretary of State has gone, as we have heard, but who will take responsibility? That is the critical issue. I fundamentally disagree with the right hon. Member for Birkenhead. If we are to hold the Government to account, it is right to find out what has gone wrong, who was responsible for it, and for that person to be held to account.

John Mann: I am sure that there will not be any hon. Members who wish to leave the Chamber until they have had the benefit of hearing my contribution. No doubt, those who do so will want to read it in the morning.
	I wish to begin by declaring two interests. Of course, my family and I are users of the national health service, which we use, and will continue to use, exclusively. I am an unpaid member, too, of the editorial board of  People Management, which is the leading human resources management magazine in the country.
	I make the point because I note that there are two young and keenly engaged Ministers on the Front Bench. In the political traditions of this country, one of the problems faced by all Governments is that Ministers change so rapidly. That has always been the case. I have never fully understood the logic whereby successive Governments of all kinds have chosen to keep changing Ministers rapidly, with Ministers moving between different portfolios. That creates a potential problem for Ministers when they inherit the results of the actions of previous Ministers, in addition to the problem of mastering the brief. The point is not specific to the debate today. It applies to the technical issues that arise in attempting to hold the Government to account.
	My suggestion to the Government and anyone else who cares to read  Hansard tomorrow is that one of the big opportunities missed in the past 10 years, as it has been by successive Governments, and which I hope a change in Prime Minister will grasp, is that Ministers ought to be trained through, for example, the Henley Management college in effective leadership skills to equip them for the management of major Government Departments. This may be the only chance I have to put that on the record before a change of Prime Minister. It is an idea that I have held and discussed with Cranfield School of Management, Henley Management college and others. It is relevant to all parties. How we manage major Departments is fundamental to the effectiveness of Government.
	My second observation is how comforting it is to have such a feeling of déjà vu with respect to union organisation and strength, and the solidarity of the closed shop. It is many years since I have witnessed such good union organisation. There are rumblings outside the House—only just outside—in traditional union style, and traditional union briefings. Traditional closed shop arguments have been accepted by the Government.
	That takes me back to the time when I tried to negotiate for young engineering apprentices who were doing four years of training but were not guaranteed employment by engineering companies at the end of it. How jealous we were of Fleet street, where there was an age-old tradition of a trade being passed from father to son, apprentices being guaranteed work, and jobs for life. The changes that took place in the mid-1980s were bitterly resented by those families and particularly by the young workers, who perceived entry to that trade as a vocation for life. I see some resonance with the Government's acceptance of the arguments and their guarantees of employment for junior doctors.

John Mann: There is another game going on, and that is called the knock, knocking of the NHS. The Opposition's motivation in having this debate, and the style of debating used, has been to knock the NHS and run it down, rather than look at the specific technical issues and how they may be improved, as the Liberal Democrats rather more realistically have attempted to do. The party that never really loved the NHS in the first place has a political agenda.
	On every occasion the Opposition attempt to suggest that the NHS is in great crisis. The best judges of that are the patients, and my area is as good a judge of the state of the NHS as anywhere else. Since I have been a Member of Parliament, the NHS in my area as been a top performer. Two years after I became an MP it became the top performer in Britain, and remains so.
	The hon. Member for North-West Norfolk (Mr. Bellingham) is no longer in his place but he referred to incompetent NHS local management. That is not what I see. In my regular meetings with management, consultants and GPs, one of whom I met to discuss some of these issues at length last week, I hear pertinent points about where they wish to see improvements, but there is pride in the fact that modern management, modern doctors and modern GPs now receive the funding that they deserve and have the tools to do the job. That is a fundamental difference from the past.
	I shall illustrate that with one of the campaigns that I ran. The hon. Member for Hemel Hempstead (Mike Penning) from a sedentary position asked what I had had to do with improving the performance of the NHS. Along with thousands of my constituents, I have made a tiny contribution. When there was not a Government but a management move to downgrade my accident and emergency department, I led the campaign—

Mr. Deputy Speaker: Order. This is not a debate about the training of Ministers or the NHS in general, it is about modernising medical careers.

John Mann: No; I am going to conclude in a minute because many Members wish to speak.  [ Interruption . ] No doubt that includes the rude hon. Member for Hemel Hempstead (Mike Penning), who is saying, "Thank goodness."
	How can we ensure that an area such as mine, which has top performing NHS services and where we have moved from small one-man-band GPs to large GP practices, can get the quality of GPs to meet the new kinds of specialties that the Government rightly want to devolve down to primary care from the hospital sector? How does that fit into the vexed question of junior doctors wanting to follow traditional forms of careers when some of the new specialties that are required are in primary care, not in the hospitals sector—an issue which official Opposition Members, as is clear from their barracking, have no desire to debate.

Peter Viggers: I congratulate the hon. Member for Bassetlaw (John Mann), who made a clever job of distracting attention from the profound concern that is felt in much of the House.
	We are facing the worst and most avoidable disaster to overtake young people in professional training. Thousands of young people are being plunged into uncertainty about their careers. The tragedy is that this disaster was predictable and predicted—it is unfolding like a slow-motion train crash. I am grateful for the opportunity to be able to contribute briefly on behalf of my constituents, who feel anger and disbelief about the present situation.
	The people involved in this disaster are mainly professionals. Of no professionals is so much asked, in terms of resilience and commitment, as doctors. When doctors commit to the profession of medicine, an enormous amount is asked of them as regards training, and there is an assumption that at the end of their training period they will eventually have an opportunity to work and that that will be reflected in a fulfilled sense of commitment.
	There is a need for change in doctors' training and most people agree that it was appropriate to make a change. However, in their manner of doing that, the Government are at fault not only in the detail but in the larger issues. They have been greatly at fault in three main matters: administration; computer failure leading to mismatches occurring, and the number of jobs.
	The Secretary of State provided several facts when trying to explain the position. I submit that those facts did not help me—and I followed her contribution carefully—to understand the position better. Apparently, there are to be 23,000 training posts and 32,000 doctors are seeking them. However, she gave us many other numbers which sought to lead us to believe that there was no problem.
	I am afraid that there is a problem, because the Government have failed to deal with the double cohort—the two different groups of doctors who will enter training in August. Some will work under the previous system and others will work under the new system.
	The Secretary of State failed to provide assurance in the case of an individual doctor in my constituency, whose mother I met today. The doctor is 28 years old, has been qualified for six years and has always wanted to specialise in intensive care. She was offered a post in August last year. It was a two-year post in anaesthetics, which would lead her to qualify in anaesthetics or go further and use her anaesthetics qualification to specialise in intensive care. Now the two-year post that she was offered in August 2006 has collapsed, leaving her with the prospect of no medical job after August this year. She is not simply a highly qualified doctor but someone who, with one other woman, rowed the Atlantic as part of her gap year.
	Doctors must be given a guarantee that they will not be forced out of training. A formula must be found to permit their training to continue. The Government need to take exceptional measures and give us progress reports. The matter must be resolved by August—if necessary, by using interim measures.

David Kidney: The county town of Stafford employs a high proportion of public sector workers because it is an administrative centre. There are workers in local government, the hospitals, the university and so on. That means that, when a problem arises in the public sector—be it last year's efforts, which were especially bitter in Stafford, to try to deal with deficits in health trusts, or junior doctors this year struggling to find a training post and feeling that they have been badly treated—it affects not only those who work in a hospital trust or another health setting, but a large proportion of the public because of their affinity with the public sector generally. That might apply to the Member of Parliament who has such an affinity because of political values, the workers because they work in the public sector, and the public, who come into contact with public services perhaps more than in other areas because of Stafford's higher than normal proportion of jobs in the public sector.
	The subject of the debate is therefore generally a serious issue for Stafford. I am happy to explain that that is one of the reasons for my participation this afternoon. However, people obviously want to bring the debate to the personal level. In preparation for the last week's return to Parliament and the Secretary of State's statement and today's debate, I met the junior doctors' leader in Stafford, local NHS managers and local providers of health education. Like many hon. Members, I have also met a junior doctor from my constituency who lobbied me about his personal circumstances, and representatives of the campaign that Remedy UK has organised for today. I am pleased to have an opportunity to take part in the debate to support the points that they made to me.
	It is worth starting from the point of view expressed in the original words of the motion. What has been extraordinary about the history of medical training in this country is that it suffered its share of severe underfunding for decades before 1997, which led to a shortage of training places. That led, in turn, to a shortage of qualified doctors, consultants and nurses in the NHS, which created quite a challenge for the new Government, who were committed to improving the situation very quickly. Although the Government could turn on the tap for more money to pay for more doctors, nurses and consultants, there were not enough of them to recruit because the training places had been cut for years before. That is an important point for hon. Members to take into account about the history of how we came to be in the present situation.
	The obvious corollary at the time was that because the money was made available and the posts were there to be filled, we recruited outside the country to fill the vacant posts. That is relevant because while people talk about the double cohort of people coming through to training posts now and the senior house officers also looking for a training post, we also have the added pressure of non-EU citizens in this country whom we recruited who still want jobs in the NHS. There was something of a failed attempt by the Government last year to squeeze them out. That in itself was hurtful to quite a large number of my constituents who came from the Indian subcontinent in order to work in this country because we needed them. All those points should be taken into account when we reflect on the situation today.
	It is a good thing, is it not, that more people are in training, completing it and coming forward in greater numbers? It is also a good thing that recruitment and retention generally in the NHS has been good over the past few years. I hesitate to say that it is good now, because I am not reading a Labour party brief and want to tell it as it is. Obviously, the Government's insistence on getting rid of deep-seated deficits, which started last year—an insistence, incidentally, that I support wholeheartedly—has led to a crash in recruitment and retention. That provides a further additional pressure—on top of the three that I have already identified—when it comes to the training places available for junior doctors now. It is easy to add them up and see that four pressures have all come to bear this year on the problem of the number of places available for the junior doctors who are seeking them.
	The review body, comprising all the bodies that the Secretary of State described, and then Ministers took the decision that this year is the year in which modernising medical careers for junior doctors should kick in. It is certainly a difficult year. In the looking back that the hon. Member for North Norfolk (Norman Lamb) called for, and in seeking attributions of blame for the current situation, a good question to pursue would be whether there was any opportunity to hold back from making it this year. However, it is fair to say that modernising medical careers is the right thing to do and has gained widespread support.
	It is remarkable that no one in today's debate has asked to turn back the clock and go back to the previous system. Every hon. Member has spoken about how MMC could have been introduced more effectively and how it should be improved in future years. In some areas of recruitment—before it was applied to junior doctors—it has been implemented without the sort of reaction that we are talking about today. General practitioners two years ago provide a good example of that.
	When I met the leader of the Stafford junior doctors, she drew my attention to certain issues that I strongly support. First, for example, it is right to standardise training standards for junior doctors seeking specialty posts. It is also probably right in this day and age for there to be an online system. It reminds me of my adult son and daughter who use the internet, rather than pen and paper, as second nature when it comes to compiling a CV for a job application. Those aspects are right and are here to stay.
	Other points that we have discussed today, however, included the scoring system, the lack of flexibility, the people who did not get acknowledgements for their online applications and felt that the applications were never read, and the doctors who felt forced to apply for jobs at the other end of the country from their families. All those personal circumstances, which I discussed with the leader of Stafford's junior doctors, were individual tragedies.

David Kidney: I agree with the hon. Gentleman. I considered whether to intervene on him earlier to say that I agreed with him on that point, but I also intend to say in my speech that developments such as these should be piloted in future. So the answer to his question is yes.
	I was describing the personal tragedies that have happened because of the way in which the system has been introduced. I want to remind hon. Members who were not here eight days ago when the Secretary of State made her statement to the House that, on that occasion, I made the point that this concerns individuals who each demand more respect from the system—and the people administering it—than they have been getting over the past few months.
	In fairness to the Secretary of State, she has apologised at least three times for what has gone wrong with the system and for the distress that that has caused to those affected. One review has proposed changes that are about to be introduced, and she has also announced a further, broader review, which has been mentioned today. The shadow Secretary of State made a temperate speech today, with many good points. One of them was about the independence of that review, and the importance of all of us having confidence in its deliberations and conclusions. That is an important point for the House to make.
	Meanwhile, making a success of the first review, with its guarantee that every junior doctor who applies for a post and states their first preference will have at least one interview, is placing a terrific strain on managers and consultants to deal with the extra work that they are being asked to do over the short space of time between now and August. It is fair to say that they are the hidden heroes who are solving this problem right now, and they deserve our thanks. The hon. Member for North Norfolk made that point earlier. A number of consultants wrote a letter to  The Times earlier this month to say that they had been placed under a lot of pressure, at a time when they had plenty of other work to do to meet the demands of patients and the NHS. We owe them a debt of gratitude. That letter, incidentally, also called for the scrapping of MTAS and a return to the previous system, so although I said that no one in this debate had asked for that to happen, other people certainly have. We should remind ourselves, however, that the previous system had serious faults too. It did not find a specialty training place for every junior doctor either.
	If the Minister listens to the shadow Secretary of State, and to my hon. Friends who have said the same thing, he will realise that there is the prospect of a win-win situation. My hon. Friend the Member for Bassetlaw (John Mann) made the point that certain areas are short-served by the NHS at the moment, and we could create a win-win situation by expanding the number of training places available for junior doctors in those areas and in specialties where there are shortages. Perhaps those shortages exist because people do not want to take on those specialties, and it would be wrong to force anyone to do something that they did not want to do, but this could give us an opportunity to ask people to look again at specialties where there are shortages, in which they might be able to do a good job. We could create a win-win situation by filling the posts that we need to fill and finding places for the people who want them. I hope that the Minister will be able to respond to that point later.
	I want to put forward some points on behalf of a doctor in my constituency with whom I have had a good, spirited correspondence on his concerns about modernising medical careers. He and I agree that we are unsure about the evidence on the number of available posts and the number of people applying for them. Obviously, the more transparent Ministers can be about this, the better it will be for people who have fears—whether politically motivated or not—about what is happening. It is clear, however, that there are fewer training places than there are people applying for them.
	My doctor correspondent makes the point about the double cohort, observing that
	"increased numbers of medical students are passing through their second foundation year and needing specialist training. The shortened training also has a big impact on the large number of senior house officers who also need to find a place on the new training pathway."
	The two cohorts are coming together at the same time. He also makes the point that non-EU doctors are competing for those posts. He concludes:
	"The new doctors in their second foundation training year have no chance of success against the more experienced senior house officers and the non EU graduates."
	I do not know that, and I bet that most people in the House today do not know it, because we are not sure whether we have enough confidence in the system to say whether that is the case. The doctor goes on to say that
	"MTAS has had to make its mark by designing an application form in which experience counts for virtually nothing. Selection is largely from the psychology questions which have no tested validity in this field. The marking of these questions is also widely variable between different markers."
	All those factors have undermined confidence in the system so far.
	I shall not name the doctor without his permission, but it is important to get his views on record. His letter goes on:
	"I should tell you that this whole exercise has also been an opportunity for government to reduce the 'power' of doctors and their representative bodies."
	Such allegations are able to be made, and to sound reasonable, because of the mess that we are in at the moment.
	There has always been competition for posts, and some people will always find themselves in short-term posts because they cannot get the specialty training that they want. I was pleased to hear the Secretary of State say that support will be available for such people after this year, but will my hon. Friend the Minister tell me more about their prospects in future years? Can they always expect to be treading water and becoming what some people call the second lost tribe, or will they have the prospect of moving on? It is in the context of their fear that they will have nowhere to go that we hear the constant talk of people being forced to emigrate to find a job.
	I shall return to the effect that all this is having on my constituents. It is demoralising for them to hear that the state is paying to train bright young people to provide a service that everyone wants and values, only to see them emigrate because they cannot be given a post in their own country. That is very harmful.

David Kidney: The hon. Gentleman cannot have been listening to what I have said. Under the previous system, not everyone got the specialty post that they applied for, so they did something else. They still had a job, however. The Secretary of State has said that nothing in the new system will change that basic fact. If they do not get a specialty training place, they will still have a job. That is the point of my question to the Minister. What are the prospects for those people who still have a job, even though it is not the training post that they want? That is a reasonable question.
	I mentioned earlier that a university in Stafford offers health training. Admittedly, it does not train junior doctors, so I will not push my luck too far in talking about issues other than modernising medical careers. I want to make the point, however, that there have been superb improvements in medical training in recent years. There have been some great developments, from foundation degrees to professional doctorates. In terms of continuing professional development, relationships between NHS employers and training providers have been much improved, including the excellent development of mentors for newly qualified doctors and other health professionals. Much better recognised training and qualifications have been developed for those in the support teams for doctors and consultants. For example, last week, at Staffordshire university, I heard about training for operating theatre staff, the pilot for primary care staff, and the current deliberations about whether help can be provided in the training of care home staff. We should celebrate all those excellent developments.
	Everyone I listed at the beginning of my contribution has said that better work force planning is needed. Nobody would disagree with that. We are dealing with one of the biggest work forces in the world, not just in the country, so it is understandable if it presents more difficulty than others. Clearly, good work force planning involves listening and research, engaging those who know what is happening and have expertise to offer, piloting changes before implementing them more widely, on which I agreed with the hon. Member for North Norfolk, and, having carried out pilots, conducting proper evaluation before the final implementation. If there are lessons to be learned from today, I hope that the Minister will accept that those points cover some of them.

Nadine Dorries: Absolutely. The majority will come back and look for jobs, and we will be faced with the problem later.
	Moreover, were I a junior doctor, I might not want to go and work for VSO. I might want to stay in this country. I might have a family and a mortgage, and might want to continue my career in the UK. Dr. Sonia Heyer, of Harrow, Middlesex, said:
	"As a junior doctor who may be unemployed this summer as a result of the present recruitment fiasco, I was delighted to learn that we may be required to seek employment with voluntary services overseas.
	I would go, provided I could secure the company of the present Secretary of State for Health, in which case I would gladly accept a mapless mission to the Amazon jungle."
	She is a braver woman than I—I would not want to go with the Secretary of State for Health. Junior doctors, however, are facing no employment during the summer, or perhaps going to work abroad with VSO, which is not what they want.
	The Secretary of State has largely chosen to ignore the problem that she knew, as my hon. Friend the Member for Gosport (Peter Viggers) described, was a train wreck in slow motion. As the Chancellor was warned of the pensions fiasco, I am sure that the Secretary of State was warned of what would happen with a double cohort. Another doctor, Dr. Judith Secker, described the process as follows:
	"It was the equivalent of taking a decision for all children to leave school at the age of 17 instead of 18. In the year when the change came into effect, all the 17-year-olds and all the 18-year-olds would be seeking university places (or employment)",
	at the same time. We all know that that would be a complete shambles, and that is what we are faced with today.
	I am sure that the Secretary of State was warned about what was going to happen, but what was put in place to deal with it? Absolutely nothing. We have two cohorts of junior doctors looking for placements all at the same time, which has caused unnecessary competitiveness between them, indecisiveness, uncertainty and worry. One doctor, a junior orthopaedic surgeon, has said that three junior doctors in the past two months have burst into tears on his ward because they do not know whether they will have a job from 1 August.
	The fact is that our doctors do not know whether they will be earning a salary. If they do not want to work for VSO, where will they go? A junior doctor in my constituency, as a midwife in my constituency has done, has applied for summer work at Waitrose. That doctor has done seven years' training and 12 months in a hospital. What kind of Government tell our junior doctors to spend their summers working in Waitrose?
	I do not want to take up too much time, and I want to allow other Members to speak, but I have some questions that I want to ask the Secretary of State. Will she let us know what will happen to the 10,000 doctors who will not be in employment? Will they be offered compensation? Will they be found work somewhere other than abroad? Will she leave 10,000 doctors without jobs? We need an answer. What will happen to those doctors? If they are unemployed, she will hear a lot more about it. Actually, I am not so sure about that, because the matter will come to fruition and hit the headlines in August, and I am sure that she will not be in her current position by that date.

Andrew Pelling: Notwithstanding the bold statement that the process is fair, it can only mean that people who have invested not only years of training, but before that many years securing the necessary qualifications to begin that training, are being given a most unreasonable deal. I would not be at all surprised if the junior doctors whom I met today said, "This is the last straw" and took up those job offers abroad, which are better than anything that the NHS can provide.
	The new system involves a great deal of uncertainty. Others have spoken of the danger of court action. There are questions to be asked about the quality of the curricula to be provided, and also about the standing of the medical training that our country provides. That standing is important not only to junior doctors but to the United Kingdom as a whole, but the "gold standard" is in danger of being compromised.
	It is always difficult for politicians to recognise that they have made mistakes, and we are grateful that the Secretary of State has been able to apologise. However, as the hon. Member for Bassetlaw observed, it takes leadership to be able to recognise that it is time to cut one's losses. If junior doctors are to be given the confidence that will enable them to stay in this country, they must be offered the prospect of jobs in the NHS through the provision of training jobs in the first place. If we are not to lose a quarter of a million pounds' worth of training for all the junior doctors who will depart these shores within the next few months, we must accept what the Opposition motion says. Jobs—training jobs—must be given to people who have invested so much of their time to become junior doctors and serve the people of this country.

Richard Taylor: The disaster that threatens to derail MMC is the medical training application service, so I shall concentrate on that.
	It seems that whatever topic is raised, it is possible to choose witnesses and evidence. The briefing from NHS Employers glosses over all the difficulties. The date of 1 August has always been a nightmare, because junior HOs have always changed over on that date. The fact that SHOs and registrars did not do so in the past has made it slightly easier, but I fear that there will now be a disaster. NHS Employers says:
	"Employers are working with their consultants and junior doctors now to ensure that services for patients are not adversely affected by the change in timing. This is vital as employers need to be confident that well qualified doctors are in place to deliver safe and high quality patient care from August 1 when the new training programmes are available."
	Sadly, as the House knows, there are no junior doctors in training in my patch, but as one of the few ex-hospital doctors in the House I have had a great many letters from such doctors. To obtain an accurate assessment of the position outside, I wrote to  Hospital Doctor asking for comments from senior consultants involved in training. I invited comments in support of MTAS and comments in condemnation of it. I received exactly 40 letters: one expressing support, one expressing qualified support and the remaining 38 expressing tremendous worry. These are not whingeing letters from consultants. In contrast to the opinion of many Members, consultants work very hard for their patients, and the relationship between a consultant and his junior staff was—I hope that it still is in some ways—that of a father and their family. I remember consultants whom I worked for who were father figures, and I hope that I, too, was such a figure to my juniors. Therefore, I take seriously the comments of consultants.
	I cannot express those comments except by reading some quotations, so I have selected brief passages from four of the letters, which I want the Minister to hear. A correspondent from the north-east wrote:
	"It is almost beyond belief that the MTAS online application form, which ignored qualifications and previous experience and relied on answers to fatuous questions, was introduced nationally without validation or piloting. Widespread scepticism and concern was expressed by a large majority of colleagues who attended MMC Recruitment and Selection Training courses with us, which was ignored."
	Comments from Aberdeen include:
	"I have personally witnessed the devastating effects this process has had and is having on our highly trained junior doctors"
	and
	"I have personally seen weak candidates being offered 4 interviews and very strong, able candidates being offered only one."
	A correspondent from Cambridge wrote:
	"If the madness continues, then in August there will be many unfilled junior hospital jobs and many junior doctors without jobs...this will be dangerous for patients...and the effect on junior doctors cannot be overestimated."
	I also received the following:
	"We will have contrived a situation where many English trained graduates leave the country and we import doctors to fill the places."
	The writer of the letter goes on to say that if he were allowed to do so he could easily fill the jobs by August.
	Finally, a letter from Northampton states:
	"I have been dismayed by the unfolding disaster that is the Medical Training Application Process. I have discussed these problems with many senior and junior colleagues and know that their views are much the same as mine",
	and
	"We have let down all these young doctors, as well as damaging the present and future health care of patients. Equally important we have lost our reputation for medical training. This is true nationally and abroad. I have just returned from a trip to Malaysia where I spoke to doctors, university educators and other professionals and the common views expressed were amazement at how the UK got itself into this mess and secondly that they would no longer consider it wise to send their bright young people to the UK to train in medicine."
	Other problems include the stupidities in the scoring system—such as applicants getting two points for having a PhD and four points for their 150-word description of their personal qualities. There are also problems to do with the time involved for consultants drawing up the shortlists, let alone interviewing, and the fact that the interviewers do not know whether applicants have put their institution as their first choice. Also, to interview all applicants who put a particular training option first would be impossible without cancelling clinics and operations. The knock-on effect on spouses and families has been referred to; such families will now face uncertainty, and there might be splits between partners and between parents. The short time that is available to relocate is also a problem, as are the costs to the NHS of relocating.
	What should we do in the future? Many of my correspondents feel that there is only one thing to do: to abolish MTAS. A professor of surgery writes:
	"Although some of our leaders are still trying to find a compromise...the bare minimum to restore confidence in our medical students and junior trainees would be disbanding PMETB and MTAS."
	Readers of  The Guardian will this week be relishing some of the most famous 20th-century speeches. Nelson Mandela has been cited, and a few words from a speech he made in 1964 are worth quoting:
	"I regard the British parliament as the most democratic institution in the world".
	I hope that the House will listen to the voice of grass-roots hospital doctors, and realise that when something is deeply unfair and wrong there is not a compromise to be had, and that instead there must be a restart.

Andrew Murrison: We have had an excellent debate this afternoon, involving a total of seven Back-Bench speakers, all of whom contributed, in their own way, to our deliberations.
	I start by declaring my interest as a registered medical practitioner, although mercifully I am not one of those caught up directly in the shambles that we have been discussing, or one of those involved in events outside this place today. A number of us went outside to speak to the representatives of Remedy UK and to listen to what they had to say. I recommend that Ministers listen to what they have to say to them, too, because they have done a wonderful job in highlighting this issue to Members.
	An NHS consultant whose daughter is a junior doctor emailed yesterday to say:
	"The whole concept of MMC had some merit but the way it has been planned and carried out is nothing short of scandalous."
	That is a pretty good way of epitomising what many of us feel about this issue. The hon. Member for Wyre Forest (Dr. Taylor) gave a series of worrying accounts in a similar vein from other consultants throughout the country. My hon. Friend the Member for Putney (Justine Greening) gave further evidence from junior doctors who had written to her with personal stories of how this catastrophe has affected them in a direct way. In her excellent contribution, she was right to ask—as a number of other Members did—that the second, Tooke, review be truly independent. That means that when Sir John Tooke chooses his team, its membership should not include those previously involved in this process, because they would inevitably bring to the debate preconceived ideas. It is important that this issue be approached with fresh eyes.
	We Conservatives have always supported the evolution of a consultant-led, increasingly consultant-delivered service, and we support the principles of MMC that underpin it. We can, of course, debate points of detail such as the removal of the influence of the medical royal colleges and their replacement by the expensive training quango PMETB in 2005. It is salutary to remember that those are the same UK royal colleges whose supervision of medical education and training was described by the Health Secretary on 16 April as "second to none".
	However, having agreed with the Government in principle, we turn to implementation. At the heart of this, of course, lies MTAS. As he threw in the towel as MMC's national director, Professor Alan Crockard said that MTAS
	"has lacked clear leadership from the top for a very long time."
	Others have used that quotation and I make no apology for repeating it. We have to ask what he meant by "the top"; I leave Ministers to draw their own conclusions. Professor Shelly Heard was similarly scathing as she quit as MMC national clinical adviser.
	The courageous hon. Member for Wolverhampton, South-West (Rob Marris), in a thoughtful intervention on the Health Secretary on 16 April, asked who would be held to account for the debacle that we are examining today. She replied in her trademark, rather breezy fashion:
	"As far as I am aware, no disciplinary or performance management steps are being taken in the Department, but no doubt that can be considered as appropriate."—[ Official Report, 16 April 2007; Vol. 459, c. 48.]
	So nobody has taken the rap for what doctors have described as the biggest crisis to hit British medicine since the start of the NHS.
	The hon. Member for Bassetlaw (John Mann) suggested that Ministers should avail themselves of the services of the Cranleigh or Henley school of management. Of course, those schools teach leadership, which is what is needed now. Next, my hon. Friend the Member for Gosport (Peter Viggers) underscored the seriousness of the crisis. He asked that Ministers give the House regular situation reports as the reviews go on. That is important, given the enormity of the problems facing the NHS.
	Much of MMC and MTAS has been designed to remove the influence of the old boy network—I suppose that one can call it that—that Ministers believe has been responsible for the appointment of junior doctors in the past. NHS Employers is a metastasis of the Government's cheerleader, the NHS Confederation. In its briefing note, it identifies the twin crimes of "patronage" and "bias" in the appointment of junior doctors. In its zeal for reform, it does not pause to consider at what terrible cost those sins have been purged. Many will believe that the Health Secretary's surgery has been somewhat worse than the disease.
	Apart from the drearily predictable NHS Confederation, there have been remarkably few apologists for the mess over which the Health Secretary has presided. Let us set aside for a moment the administration of MTAS, which has caused so much heartache, and focus on modernising medical careers. We can applaud the intention to move forward to a more focused, competency-based training that reflects what has been happening in other trades and professions, and in other countries. We hope that training will be more flexible and, as women make up half the medical work force, that it will facilitate a better work-life balance. It is surely right that doctors are better able to communicate with patients and colleagues, and that communication is a key element in any training or assessment process. Modernising medical careers recognises that, but we have grown an inflexible monster that forces early job choices on young doctors that will be difficult to move out of and into. Practical experience will be curtailed and all of a sudden that "second to none" training about which the Health Secretary boasted in her speech last week is beginning to look far less robust.
	MTAS is truly remarkable. In place of a CV and hard data encapsulating hard-won academic qualifications and clinical experience, applicants are invited to furnish a load of soft mush. Other hon. Members have mentioned scoring, and the hon. Member for Stafford (Mr. Kidney) referred to that. The essential concern is that the influence of PhDs, for example, has, as we discussed earlier, been eclipsed by offerings in essay form that are made up at short notice and in a way that, as my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) noted, is capable of being imparted in a course that costs very little.
	Certainly, the current system encourages creative writing and theatricality. No doubt they are invaluable attributes, but they are hardly core competencies for aspiring consultants—even, if I may say so, for consultant surgeons. I understand from a written answer sent to me on 13 March that MTAS will cost £6.3 million over five years. Can the Minister who will wind up the debate confirm that that does not include the cost of the paraphernalia of failure—review groups, appeals, judicial reviews and so on? I assume that it does not, because last week the Health would cost.
	On 16 April, the Health Secretary said of the extra resources required by the first—the Douglas—review that
	"the service around the country will in many cases need to release consultants from their planned activities in order to make time available for the additional interviews."—[ Official Report, 16 April 2007; Vol. 459, c. 45.]
	What assessment has the Minister made of the cost in front-line patient care caused by the crisis? What will be the impact in the next few weeks of the redeployment of medical staff apparently necessary to patch up MTAS? How many operating lists will be cancelled, how many clinics scratched, and how many ward rounds foregone?
	The hon. Member for North Norfolk (Norman Lamb) is worried about logistics, costs and wastefulness, and rightly so. I am delighted that the Liberal Democrats will support our motion this evening.
	On 19 March, the Health Secretary said that
	"shroud-waving about unemployed doctors is absurd"—[ Official Report, 19 March 2007; Vol. 458, c. 582.]
	On 16 April, we had more assurances from the Secretary of State when she said that she wanted to take
	"the opportunity to refer to the thoroughly misleading statements made in recent weeks about the prospect of thousands of junior doctors finding themselves without work. This is complete nonsense."—[ Official Report, 16 April 2007; Vol. 459, c. 46.]

Andrew Murrison: The Health Secretary is nodding. In contrast, however, NHS Employers has at least some grip on reality. We learn from its leaked report of how it is desperately scratching around for jobs abroad to offer doctors that it recognises will be unemployed on 1 August. The NHS Employers briefing paper talks optimistically of service posts that have been converted by employers into training posts. How many of those have there been after Lord Warner's announcement of 13 December, and how many more does the Minister anticipate? Other hon. Members have made that point already, and it is important that we know the numbers involved.
	While NHS Employers has been trawling the world to see where it can park unemployed British doctors, has it asked our EU neighbours how they might help? Given that many of the available training billets in the UK will be going to European economic area doctors, it seems reasonable to ask where the reciprocity is. The right hon. Member for Birkenhead (Mr. Field) spoke about banning European doctors, and that point may be germane here. Certainly, we recognise that the treaty obligations into which we entered—rightly or wrongly—forbid us from banning European doctors. That is simply not possible, but NHS Employers might consider Europe as it trawls around the world. Many Labour Members have been greatly exercised in the past by unpaid researchers attached to MPs' staffs. In a like manner, are they not concerned that officials are entertaining a scheme to hive unemployed junior doctors off into voluntary service overseas? What would be the precise terms of such an arrangement?
	Heaven for junior doctors will be a place on a run-through training programme. The Government are saying, "Get that and you're well on your way to consultant status, in due course. Fail and you're set for a grisly series of fixed-term specialist training appointments, so-called locum appointments for training, a re-run of your second foundation year"—how depressing must that be?—"undefined academic appointments of the sort we thought MMC was designed to address, professional 'locumming' and a constellation of low-grade, non-training jobs. You'll be part of your postgraduate dean's euphemistically styled 'talent pool', to be fished out when something vaguely suitable turns up."
	I hope that that "something suitable" does not involve working in a supermarket, as happened to the constituent of my hon. Friend the Member for Mid-Bedfordshire (Mrs. Dorries). The lost tribe of senior house officers is set to become nomadic as they drift from hopeless job to hopeless job with little chance of breaking out, in stark contrast to the previous flawed, but far less rigid, milieu. It is little wonder that so many dedicated, expensively skilled professionals are set to quit the UK and the NHS, and even to quit medicine altogether, as my hon. Friend the Member for Croydon, Central (Mr. Pelling) pointed out.
	The Health Secretary's fulsome apology last week was indeed appropriate, but junior doctors facing the prospect of being hung out to dry want to know why she is not joining them.

Andy Burnham: The hon. Member for Westbury (Dr. Murrison) is right to say that this has been a good debate, and I shall do my best in the time available to answer some of the points that have been raised.
	This matter is of fundamental importance to the country. We must ensure that patients get the best possible care from highly trained and motivated staff, but we recognise that there has been a significant impact on the lives and careers of those dedicated and hard-working staff who are applying to progress their training as doctors in the NHS. Young people and their families will be watching today's proceedings closely, and we know that they will have gone through considerable anxiety. I know from the emails that I have received—and I am sure that other hon. Members of all parties have received similar messages—that there has been considerable anxiety about this matter. It is right for the Government to address that and to give people practical information so that we can map a way forward.
	My right hon. Friend the Secretary of State began by setting out the principle of modernising medical careers. One of the interesting things about today's debate was the degree of agreement on both sides of the House, expressed by almost every Member who spoke, about the principles behind MMC. The programme has the potential to benefit both doctors and patients in the NHS and it is important to note that its foundation stages have been successfully introduced. We believe that we can build on that success.
	The difference between us and some Opposition Members is that they suggest that all the measures were hatched in secrecy in the Department of Health and that we did not involve anybody else in drawing up plans for this stage of the implementation of the MMC programme. That is not the case. We have worked closely with the Academy of Royal Medical Colleges, the BMA, NHS Employers and others over a long period. However, we are not washing our hands of the issues. We have tried to face up to them, but the important thing is to take action now to help people and to put in train a wider review of the system so that when this year's process is over, we can ensure that lessons are learned and that, in time, we can bring in a strengthened system.
	The suggestion crept into many of the comments today that there were no unfairnesses or problems in the old way of doing things. That simply is not the case. If we accept the principles of MMC, we must also accept that there were myriad unfairnesses in the old system. The difference is that those unfairnesses were not out in the open, in the transparent way that they are now— [ Laughter. ] It is because they are transparent that we can work through the issues that have been identified and create a fairer training system for doctors.
	The hon. Member for North Norfolk (Norman Lamb) made a speech that was good in many ways. He, too, endorsed the principles of the programme and observed that patronage and bias had been problems in the past. Despite the laughter from the Conservative Benches, the hon. Gentleman was right to identify those problems. He suggested that the system was too inflexible—a point raised by the shadow Secretary of State in his opening remarks. I draw the attention of both Members to one of the points in Sir John Tooke's terms of reference:
	"the lack of flexibility available to trainees on run-through programmes".
	Sir John will examine that specific point in his review.
	The hon. Member for North Norfolk spoke about the lack of a pilot for the scheme. In fact, the electronic portal for foundation recruitment was piloted in 2006. The application form was based on an existing form used in the London area, and the current form was piloted pre-launch in at least two deaneries. At the end of the day, we can review the programme and consider whether there was enough piloting and I shall take on board the conclusions of the review. However, it is not the case that the scheme was rushed through with no attempt to consult or to pilot.
	The hon. Gentleman asked how many extra interviews would be required. Originally, 26,000 non-GP interviews were scheduled. The number of extra interviews required following the Douglas review will depend on how many junior doctors change their first preference. As the hon. Gentleman knows, that process has been going on over recent days so it is obviously too early to give him the figures. However, we estimate that guaranteeing one interview for each eligible applicant will require between 13,500 and 23,900 interviews. The number will depend on how many doctors change their preference. We shall of course need to balance the requirements of the service—another point made by the hon. Gentleman. We believe that the provision of extra interviews in round 1 is likely to reduce the number required in round 2, but we shall work through that issue as we go further down the line.
	We shall not know how much additional cost will be incurred until the end of the process. However, the proposals have been agreed with the deaneries and NHS Employers. We believe that is the right action to take, because it will bring back a degree of fairness and meet the complaints we faced—that the system was unfair and people were being denied opportunities. Like the hon. Member for Westbury, the hon. Member for North Norfolk asked about the provision of care to patients during the period of the review. We shall not relax any service standards or targets.
	The hon. Member for North Norfolk asked my right hon. Friend the Secretary of State about the 700 posts that are to be added. Originally, a small number of one-year posts was held over for round 2. After the review group's recommendation, those posts were loaded on to the system for the extended round 1, so the 700 posts will soon be available on the system. I hope that that answers his question.
	My hon. Friend the Member for Bassetlaw (John Mann) made an interesting point, which again goes back to the principles of the MMC programme. He asked about the needs of communities such as his, where traditionally there have been problems in the recruitment of both hospital-based staff and GPs. My area is in a similar position. My hon. Friend the Member for Houghton and Washington, East (Mr. Kemp) pointed out that in his area, too, there were real difficulties in recruiting more GPs. MMC is being introduced to ensure that we can address those recruitment problems, especially for shortages such as that of GPs in the north of England. In principle, the scheme enables people to move from over-subscribed to under-subscribed specialties and we believe that the review group's proposals for early announcement of recruitment for GP training will encourage applications in that field, which has traditionally been under-subscribed.
	The hon. Member for Gosport (Peter Viggers) asked about double cohorts and why we could not guarantee everybody a place. May I give him a snapshot of the situation? At present, about 3,000 senior house officers are training in surgical specialties, feeding into about 500 specialist training opportunities for surgery. It is the case, as it always has been, that not everybody can be a consultant surgeon. The difference is that under the old system people hung around trying to progress their careers, but could not obtain opportunities to do so.

Caroline Spelman: I accepted an intervention from the hon. Lady at the beginning of my speech and, if she will bide her time, I shall come on to the question of refuse collection.
	The report contains a series of additional ways of taxing people that the Government have refused to rule out. The only option ruled out so far is the bed tax on British holiday makers, which will certainly please my hon. Friends the Members for Brentwood and Ongar (Mr. Pickles) and for East Devon (Mr. Swire), who campaigned against the proposal in our seaside resorts. That brings me on to the proposals that the Government have not ruled out, including the call for additional tax bands at the upper end and for changes to the ratio between the bands. In particular, appendix C models changes from the present 3:1 ratio to 5:1 and even 10:1. To put that in layman's terms, on a band D property, the bill would go up by as much as £119. That is the tip of the iceberg. Rebanding cannot take place without revaluation, and revaluation will mean that bills go up. That is exactly what happened in Wales. Despite assurances from Ministers that the revaluation would be revenue neutral, four times as many homes moved up a band as went down, and the average bill went up by 10 per cent. in the first year.
	We fear that that would happen in England. No one is under any illusion about how expensive and intrusive revaluation is.  [ Interruption. ] Regardless of whether people own their home or rent it, they will be taxed on home improvements and the quality of their neighbourhood.  [ Interruption. ]

Caroline Spelman: Apart from the fact that that shows a remarkable lack of understanding of the way in which many prudent Conservative councils have striven hard to maintain front-line services, notwithstanding central Government grant settlements which, in many cases, are inferior to those of councils controlled by other parties, the hon. Gentleman showed a marked lack of understanding about the kind of moral judgment that I have tried to make. I genuinely believe that the amount of money wasted on the whole unelected regional empire created by the Deputy Prime Minister would be much better spent on front-line services, particularly in adult social care.
	In the face of the crisis in local government funding, I used to think that the Government were guilty of standing idly by, but in fact, that is not true. The Government are actively making the situation worse. Two in three councils report that NHS cuts have had a direct impact on social care provision. While councils strained every sinew to make efficiency savings at the Government's request, to the tune of £220 million last year, the Government simply load them with more cost burdens, form filling and money-draining bureaucracy. The latest example is the Government's decision to embark on a round of costly and unpopular restructuring. Have the Government become so detached from reality that they think that restructuring should be a priority? If that is the case, frankly, Ministers ought to get out a bit more. Sir Michael Lyons was right to say:
	"Reorganisation is not, in most cases, likely to provide either a theoretical or practical solution to the challenges we face."
	That is the view of the man whom the Government commissioned to look into the future of local government. When I was canvassing for the local elections, no one spontaneously asked me for the restructuring of their local council.

Robert Key: Is my hon. Friend aware that my constituents hope that the Government's crazy proposals to go for a unitary structure of Wiltshire will be proved illegal? What really makes them angry, however, is the fact that there has been no consultation, no referendum, and no boundary review, given that the Boundary Commission requested the change. It is, in fact, taking democracy away from local people, which is exactly the opposite of our localisation agenda.

Peter Soulsby: The hon. Lady is making a case against the restructuring of local government. If it is, indeed, as mistaken as she suggests, will she explain why almost half the councils seeking restructuring are Conservative-controlled?

Caroline Spelman: My hon. Friend is owed an answer by the Government. On previous occasions we have had no answer to the question of where in legislation there is the power to enable the Government to force the recovery of costs on councils that refuse to comply with the Government's model of restructuring.
	Even more astonishing to all of us watching the way in which the Government have imposed their will on local authorities is the fact that in Shropshire, of all places, the referendum produced a quantifiable result showing that there was no broad measure of support for restructuring, yet flying in the face of that opposition to restructuring, the Government allowed the unitary bid to proceed. That is difficult for us to understand and accept.
	People are being asked to pay more in taxation for less representation, without being properly consulted in the first place. Making that sound appealing must be the ultimate in political alchemy. How on earth does that square with localism? If we are serious about getting decision-making closer to the people, surely we should be strengthening local councils, rather than abolishing them. Restructuring is about taking decision-making further away from local communities, just like that other great folly in local government, regionalism.
	Is the Secretary of State content with her Department's legacy being one of forcing unwanted and unelected regional government on people against their will, abolishing people's local council against their will, and then charging them a 92 per cent. premium on their council tax bill for the pleasure?
	Labour has played fast and loose with local government. The Deputy Prime Minister sold it down the river for the sake of his unelected regional empire, the Environment Secretary spent his time entreating chief executives to join him in abolishing one another's councils, and the Chancellor has spent a decade reducing councils to mere tax collection agencies, rather like a latter-day sheriff of Nottingham. I do not want our country to be governed like that.

Anne Milton: Does my hon. Friend accept that in my constituency, Guildford, the thing that makes people most angry is not only the exorbitant council taxes that they are now paying, but the feeling that they have no impact on what happens in local communities, that decision-making is being taken further and further away, and that the Government are dictating to local councils and neatly hiding behind local decision-making when they choose to?

Caroline Spelman: I thank my right hon. Friend for his intervention. He points out clearly that a whole industry of inspection that did not exist before 1997 has been imposed on local government from the centre and has cost council tax payers £1 billion in hard earned money. That money would be much better spent, as I suggested earlier when the question of social care came up, by being returned to the front line, where it is much needed. For the avoidance of doubt, we have said on many occasions, and I will repeat it again, that we would scrap the comprehensive performance assessment and best value, because we believe that that money could be better used elsewhere.
	I want local government to be the real engine room of local decision-making, not a mere agent of Whitehall. I want town halls to have freedom and discretion to spend taxpayers' money in a way that reflects the needs of local communities. That is why we have proposed the Sustainable Communities Bill, a Bill which the Government rather complacently see as unnecessary. Giving local communities the right to decide the spending priorities for their area is necessary. It is also necessary to give planning decisions back to town halls, rather than regional quangos and Whitehall Departments. Crucially, it is necessary to get council tax back down to sustainable levels. When it was first introduced, people were not protesting on the streets and pensioners were not going to prison.
	Through their abuse, the Government have made the council tax a stealth tax that is extremely unpopular. It is not an unreasonable aspiration to return the council tax to sustainable levels, and there are significant savings in wasteful bureaucracy that could be directed to the front line. What we need is a change in the culture of government, from one that sees local government as an obstacle to one that sees local government as a solution.

Caroline Spelman: The hon. Gentleman clearly has not been listening to the debate because I have explained that on at least three occasions, and most explicitly I quantified the savings that would accrue from scrapping the comprehensive performance assessment and best value. That currently costs taxpayers £1 billion a year—£1 billion that could be used much more effectively and is urgently needed in areas such as adult social care.
	It is clear to me that after 10 years of eroding local decision making and fleecing council tax payers, the only way of creating that change in local government is through a change in national government. That is why I invite voters to use 3 May to send precisely that signal.

Mr. Deputy Speaker: Order. I only want Opposition Front Bench interventions if they are proper in nature, not sedentary.

Ruth Kelly: Thank you, Mr. Deputy Speaker. I must make some progress with my speech.
	It is clear that the Opposition do not like to talk about their record in power or when they were last in government. I can tell the House that we are proud of our record. In 10 years, Labour has transformed local government. We inherited services that were run-down, demoralised and starved of cash. Since 1997, we have increased funding to local councils by 39 per cent. in real terms. Our massive investment, together with the commitment of local government workers, has turned things around. Today, local government is not just up to the job: in many areas, it is leading public service reform. It is delivering results on the issues that really matter. Rates of recycling have more than tripled in the past eight years, antisocial behaviour is falling, 3,500 neighbourhood wardens are helping cut crime on our estates, and the streets are getting cleaner. The Audit Commission shows councils improving year in, year out.

Barbara Keeley: Does my right hon. Friend agree that part of the difficulty that the Conservatives have in getting people elected in the north, particularly in cities such as Manchester, might be the example of Tory-led Trafford council? Perhaps it is time to condemn that council, which is not prudent. It has not only increased its council tax by the largest amount in Greater Manchester—4.9 per cent.—but is making its citizens pay the council tax every month on days earlier than they are used to paying it, and has wasted money on the new council logo and £400,000 on consultants at the same time as closing two day-care centres and an elderly people's home.

Ruth Kelly: I certainly condemn the Tory councillors on Trafford council. It is worth reminding the House that those in Labour-controlled councils are seeing their council tax go up by much less than those in Tory-controlled councils throughout the country.
	I must turn to the interest that the hon. Member for Meriden expressed in our council tax policy, as she made so much of the Lyons report in her speech. That gives me a chance to set the record straight. We have no plans to revalue properties in this Parliament. We have no plans to introduce new higher and lower council tax bands in this Parliament. We have no plans to replace bands altogether with a system based on the individual value of each home. The Tory policy on council tax seems to consist of tabling endless parliamentary questions about patios and bathrooms while dreaming up stories to scare people about spies in the sky and inspectors who are going to kick the door down. If one was to believe them, one would think that every home has a helicopter hovering above it taking pictures of patios and every bed has a home inspector lurking beneath it. One of my favourite parliamentary questions is the one tabled by the hon. Member for Meriden that asks what is the Valuation Office Agency's definition of a bathroom and whether a room with a shower but not a bath is classified as a bathroom.
	People could be forgiven for having expected the hon. Member for Meriden to set out the Conservatives' policy on council tax today—would they keep it, would they scrap it, or would they reform it?

Andrew Stunell: Liberal Democrats greatly welcome the time that has been set aside for the subject of the debate. If we want a healthy democracy and a responsive and participative society, with effective and efficient services, we must have strong democratic institutions at every level, especially in local government. There could hardly be a better time to debate the future of local democracy and local government than 10 days before the biggest round of local government elections in England for four years, and on the eve of some historic local government elections in Scotland, for which a proportional voting system will be used for the first time.
	This evening we have a chance to examine the competing plans of the political parties for strengthening and enhancing democracy and for better participation in our society. It is an opportunity to consider parties' plans for delivering effective local services and improving the well-being of our local communities.
	It was therefore a genuine disappointment to be presented with the Conservative motion. The shadow Minister, the hon. Member for Meriden (Mrs. Spelman), did her best, but even her best could not disguise the fact that the motion contains only half an analysis of the problem, no diagnosis and no effective remedies. For long sections of her speech I thought that she was reading a succession of Conservative election leaflets. She paid little attention to the severe and serious problems that we should be addressing when we discuss the future of local government.
	The Conservatives' first motion today was 18 lines and their second is only nine lines. It is a pity that they did not find another few lines to add to their second motion to give us a clue, a faint hint or even the ghost of an inkling of what they believe should be done to ensure a secure future for local government.

Paul Beresford: I shall be succinct. I wish to make only two points, which I am delighted that the Minister is present to hear as they are aimed predominantly at him.
	First, I recommend that the Minister changes the system of listening to local government following the distribution process. My right hon. Friend the Member for Skipton and Ripon (Mr. Curry) and I regularly did that, and the hon. Member for Hazel Grove (Andrew Stunell) mentioned it. Some councils have good causes and it is possible to change things to help them. In respect of others, revealing information can be discovered, especially if one does a bit of work beforehand. I found a few Labour councils to be difficult in terms of some of the positions that they took, and I found that some Liberal Democrats positions were extraordinary.
	I cannot remember if it was the Liberal Democrats group that came with the Minister for Hazel Grove, or rather the hon. Member for Hazel Grove—that might have been a Freudian slip, although I hope that we never have a Minister from the Liberal party. The Liberal Democrats council members came after having worked all night—or so I was told—on a project, and they were determined to put their case, which they did. We listened carefully to them. Their case was demonstrated with graphs, until it was pointed out by me and one or two of the officials that if the axis of the graphs were changed slightly exactly the reverse argument to that they were making applied. That is an entertainment that I suggest the Minister tries. He will find that the position of the hon. Member for Hazel Grove is often pretty fraudulent.

Paul Beresford: What a shame—I could have gone on a little further, but I do not have the time.
	My second point is that the Secretary of State and Ministers have in the past gone on at some length about the fact that they were removing some of the ties and burdens on local government. That was a little fraudulent because the burdens referred to had been imposed on local government by this Government. It is a bit like someone having an arm handcuffed to a wall for a number of years and then the people responsible saying, "We are now going to release you", and then asking him whether he feels better—when at the same time another Department has nailed his other arm to the wall.
	Some of the effects can be followed. The best value system was introduced—that title is a misnomer if ever there was one—as was the comparative performance assessment, which brought with it myriads of targets and books of prescriptive guidance, and other Departments joined in. The best example I can give involves Mole Valley district council. It is a tiny council with a budget of £10 million. The last comparative performance assessment cost it £250,000, plus weeks of getting ready and dealings with auditors and so forth. The Audit Commission has been mentioned—I understand that it is five times greater than when we left power and Labour came to office—and it is merely hounding local government. When that £250,000 was geared—it is geared, as it moves on to council tax—it added £1 million to local tax for that little council with a budget of £10 million. That is outrageous. The Secretary of State has said, "Well, we are taking it away", but other things have been added, not only by his Department but by other Departments.
	The Secretary of State spoke with some glee about the local area agreement. It has been hyped as a new way of streamlining funding and reporting. I invited the Minister to come with me to a certain well-known Conservative council that he likes very much and that endears him to local government, and to listen to it independently on what this means to it. It means excess bureaucracy and time-consuming work. There are hundreds of pages of prescriptive guidance on process, on format—on all the agreements. It means minute scrutiny.
	I rang the council and spoke to the chief executive and some of his senior staff to ask whether the situation got better after my attempts to get the Minister to take notice and to reduce bureaucracy. The chief executive said, "No, it's worse. There are more mandatory indicators, all of which are based on national priorities and all of which effectively remove the so-called local aspects. Moreover, there are more than just the six-monthly reviews."
	The chief executive also said that he was looking forward to September, when the local government section of the Department will descend on him and his council. Little boys and girls just out of university and with no real understanding of life will descend on the council to tick it off and to tick various boxes. Rather than looking at actual outputs, they will be looking at process. That will cost the council a lot of money, and the situation will then be exacerbated by the gearing. An horrendous amount of time will be wasted, the costs will be ghastly and the gearing will exaggerate the process. If the Minister actually believed what he has been saying and got off local government's back, there would be a reduction in costs and a reverse gearing effect on council tax.

Alison Seabeck: This has already proved to be a highly emotive debate, which is indicative of just how important local government is to Members. Sadly, it has also been very predictable. It has clearly been a simple mechanism to enable the Opposition to run scaremongering stories, in the final week of the local election campaign, that have no foundation in fact. As chair of the all-party group on local government, that saddens me enormously. I would therefore like to focus on the positive aspects of the all-party group's work and on some specifics of the future of local government.
	The all-party group, supported by the Local Government Information Unit, is reviewing the possibility of enhancing the role of the councillor and of encouraging more people from diverse backgrounds to step up to the plate and seek election, thereby bringing with them a wealth of experience. We hope to feed our findings into the Roberts review being undertaken for the Department for Communities and Local Government. The future of local government depends in part on the quality of the people whom we attract as councillors. The stream of negativity from the Opposition today is hardly a good advert for the job.
	The all-party group heard from a range of witnesses—from councillors from all the main parties, from experts such as Professor Steve Leach, from Paul Wheeler of the political skills forum, from Dr. Stuart Wilks-Heeg of the university of Liverpool, and from those representing minority groupings. We also asked the media to participate. There is an enormous amount of enthusiasm from elected representatives who have submitted evidence on the role that they have undertaken, and for the innovative work going on within existing parameters to engage the public more widely, and to assist them in understanding the service that their council and councillors can offer.
	Interestingly and in contrast with today's debate, the all-party group meetings have been productive. It has been largely agreed on a cross-party basis that some of the problems flagged up tonight can be resolved only if we move forward in a more consensual and positive way. The view has also been expressed that the best authorities already make good use of existing powers to reach out to their residents and electorates. There is some excellent practice out there, and the Government's beacon council scheme certainly does an excellent job in highlighting best practice and disseminating information more widely.
	A number of Members have, through various early-day motions and private Members' Bills, supported the extension of local authority power and the wider empowerment of individuals in their relationship with their local council. The Local Government and Participation in Health Bill takes forward most of the key strands of the ideas being put forward and further enhances arrangements through local area agreements, for example, without some of the drawbacks of the measures proposed by others. The Opposition pamphlet setting out their position on sustainable communities raised concerns from experienced Members in all parts of the House. It suggested that local authorities should be given greater powers to set targets and to establish programmes directed at local needs, but quite how that fits in with proposals that would require Whitehall to deliver an action plan to achieve them I cannot imagine. Full cognisance does not appear to have been taken of the fact that local decision making means decision making within the locality.
	It is unclear how the Opposition's proposals would be achieved—how the mechanisms and the administration of their proposed scheme would be handled. Given their dislike for all things regional—and, by default, for regional offices—would they move this power and responsibility toward the centre? They have come up with few genuine proposals for the future of local government that stand up to scrutiny, and we have heard nothing new from them today. However, the Local Government and Public Involvement in Health Bill has managed to obtain broad support, and its passage through Committee was notable for the positive and often consensual debates that were held.
	That approach has been mirrored elsewhere. Lord Bruce-Lockhart, the Conservative chairman of the Local Government Association, welcomed the White Paper that preceded the Bill, saying that it reflected the growing confidence in, and competence of, local government, as well as the belief that the best way to deliver the best services to local people is at a local level. Front-line services should be focused on the needs of those who use them. Lord Bruce-Lockhart also acknowledged that the proposals would help to free up elected councillors to put local people first in the delivery of the right services at the right time and in the right place. Many of the witnesses to the all-party group have supported the view that the Local Government and Public Involvement in Health Bill is a real step in the right direction and that the challenge is there for authorities and individual councillors to grasp the opportunities presented to them.
	The Leader of the Opposition talks about taking responsibility and the avoidance of Government interference in other areas. He should, therefore, support what the Government are trying to achieve with local government. The Government want to release some of the central controls and to enable far greater control over decision making to be devolved to councillors and citizens.
	In his report, Sir Michael Lyons reaffirms the importance of local decision making and sees a positive future role for local government in fostering a new public confidence in our local governance arrangements. It is an incredibly detailed and thorough piece of work, as one would expect from Sir Michael. Although he dwells at length on a number of matters outside the question of taxation, Sir Michael does tackle the thorny issue of trying to find a solution to the perennial problem of local taxation.
	It would be in all our interests to resolve that problem once and for all and to accept that, at least in part, local taxation needs to be property based. No tax is popular, but every party in this House that aspires to being in government should want that problem sorted out in a way that at least enables local government to operate on a sound footing, plan long term and offer clarity to the taxpayer. The approach that I have suggested would also promote a greater sense of fairness and justice than currently exists.
	The Opposition have tried to imply that the Government want to introduce a waste tax in addition to the council tax, but that is merely further scaremongering. That proposal was simply one of the many options put forward by Sir Michael Lyons for consideration. Local authorities of all parties are looking at mechanisms that would enable the better management of waste. Some are using sticks and others carrots: for example, Conservative Barnet council has been targeting residents in respect of waste, and fining them. Which council can say that it would not want to use such a power in the future?
	When I sit through our debates on local government, I am always saddened to hear the unremittingly negative comments from the Opposition. They have yet to come to this House and offer any serious positive proposals that will help local government move forward. Hon. Members on the Opposition Front Bench could take lessons from those of their colleagues on the Back Benches who attend the all-party group. They contribute in a positive way, and understand the important contribution that local government and local councillors make to their communities.
	It may be that the Opposition's attitude to local government is still shaped by the 1980s and early 1990s, when local government was seen as a nuisance. It was the subject of swingeing cuts that caused morale among councillors to plummet, but the mood now is very different. Yes, councillors have been subject to inspection—but what a difference that has made. There has been an impressive turnaround in the number of authorities ranked as good or excellent—

Alison Seabeck: I shall be gracious to the hon. Gentleman, as his participation in the all-party group has been generally positive. In all fairness, I must say that he has made some useful suggestion and has enhanced the discussion.
	Local authorities have learned how to be self-critical, and how to seek out best practice elsewhere. They have gone from saying, "What can central Government, or indeed the public, possibly know about running a council? We know what we are doing" to saying, "Perhaps we can learn from others. Could we do a little better? Can you help us to improve our services?"
	The Government should be congratulated, as should the councillors and officers who have put so much effort into this transformation. My local authority, Plymouth city council, was close to being placed on special measures while it was under the control of the Conservatives. In order to get elected, they made rash spending pledges that took money away from core services, such as transport and waste disposal. On election, they frittered money away and made no attempt to put the authority on a sound financial footing. They still oppose green transport plans and only this week abstained on the urban strategy.
	The Labour administration, led by Tudor Evans, took the bull by the horns, dug deep to understand the true nature of the problems and took difficult decisions, showing real leadership. Plymouth is back on track and it has the lowest council tax in the south-west. Across the country there is clear evidence that local government is at last coming out its shell—under a Labour Government.

David Curry: I draw the attention of the House to my entry in the Register of Members' Interests.
	After listening to the speeches from the Front Benches, I realise that we are obviously all devolutionists now. However, if we are to be devolutionists there are two preconditions—a fixed idea of the direction of travel for local government on structure and on revenue. Until those two basic frameworks are in place, we cannot have an orderly, sensible and sustained process of devolution.
	We are in the middle of a new round of negotiations about unitaries. The Government seem to have stumbled into those negotiations and they need to make up their mind what structures for local government are available—I use that word deliberately. The truth is that we live in a centralised state at the moment and because we are trying to move towards a more relaxed system, devolution—or localism—will by definition be a managed process, so how we manage it is important.
	It is a question not just of local government structures but also of the configuration of all the other bodies whose responsibilities touch local government: the regional development agencies, the learning and skills councils, planning bodies and Government offices. The implications of devolution are huge in terms of the whole geometry of regional governance.
	The Government have been a bit all over the place. There was a period of enthusiasm for elected mayors, but then it was realised that impregnable Labour cities which it might take us several elections to have a go at in the normal course of events could fall at a single blow in a mayoral election when an outsider entered the race. Then there was the period of enthusiasm for universal unitaries, when the present Secretary of State for Environment, Food and Rural Affairs made a brief stopover at the Office of the Deputy Prime Minister as Minister of Communities and Local Government.
	We are now in the period of unitaries à la carte, so I am interested in where the debate on city regions will go. Representing my part of the world, I am a supporter of city regions and can see the logic in planning and skills terms of trying to treat as a whole not only metropolitan areas that abut one another but also the districts that supply that travel to work area.
	We want to know which direction the next regime will take. We have heard the contributions of the Chancellor's Yorkshire outriders, the Financial Secretary to the Treasury, the hon. Member for Wentworth, and the Economic Secretary to the Treasury, the hon. Member for Normanton—I suppose they might be described as two of the horsemen of the Apocalypse.
	Capacity and accountability are important. The hon. Member for North Swindon (Mr. Wills) said that Swindon did not have the capacity to be a unitary. There is a real dilemma. The Government have insisted that we need more capacity in a number of sectors, so the health service has been reorganised to create more capacity. We were embarked on the creation of more capacity in police services, but the Government have withdrawn from that process. The dilemma is: to what extent do we trade off capacity for accountability? We are all legitimately concerned about the responsiveness of our institutions to the general public and about people's disengagement from the political process. However, if we unremittingly seek capacity as the sole good, the cost will be paid in terms of identity and accountability.
	I am sympathetic to the notion of the small unitary, because I want councils whose leaders can be recognised and accosted in the street, as happens in many French areas—it is well known that I have some sympathies for the way the French do these things. We recognise that accountability has a cost, but if we are to move through local authorities to devolve to the citizen, we must make sure that there are accountability structures. Whether we call it civil society or the third sector, the bodies in it may be very admirable but they are not necessarily representative. They are there to pursue a particular aim and we have to make sure that people speak for the wider community and not for particular interests exclusively.

Chris Mole: Far be it for me to suggest that the right hon. Gentleman is again showing up those on the Opposition Front Bench, but I genuinely believe that he puts his finger on one of the dynamics of public service—whether it be local government or elsewhere— which is the trade-off between neighbourhoods and local accountability and the strategic capacity, efficiency and effectiveness of organisations. Given his wisdom and expertise in government, I would be really interested if he could give us his thoughts on how we might take the debate forward to ensure that we best resolve the problem without the usual yah-boo that seems to get in the way of addressing some of the challenges in local government.

David Curry: I am grateful to the hon. Gentleman for those remarks. I agree with him about the importance of the issue and I will certainly look for occasions to develop it if we are to put substance on our localism agenda. Meanwhile, if he is kind enough to pay attention to them, I will do my best in my columns.
	The second issue that is of concern to us tonight is funding. The present situation is not sustainable. Business rates are frankly off the agenda; I do not see anybody introducing them against opposition. I regret that, because they should be returned to local authorities. The circumstances that led to their nationalisation are past and there is a huge history now of working between business and local authorities. In fact, incorporating mechanisms that safeguard against abuse does not require a PhD. Relatively simple mechanisms can be deployed and I hope that we will move back to recognising that.
	Revaluation is also probably off the agenda. I rather regret the fact that the Government backed off that; they have rather backed themselves into a corner in doing so. I note the Secretary of State's little words "in this Parliament" and I look forward to the manifesto that says that if Labour is re-elected, it will reband and revalue in the next Parliament. I suspect that I will scan for some time before I identify that.
	The problem with charging is that people now find the council tax so highly objectionable that their tolerance for adding additional charges on top of that is not what it might have been a number of years ago. The council tax is more than ever centre stage, because nobody tonight has mentioned the fact that schools funding now goes directly to the schools. If one abstracts schools funding from the formula, one sees that council tax is getting on for half the revenue of some local authorities. It is a much more high-profile tax than it was. Redistributive business rates and council tax now form a huge element of the tax resources of local authorities.
	Of course, we need to explore the implications of the Lyons report. Even though Sir Michael has now gone to his earthly reward—although I am not sure that the BBC should be described as all that earthly—there are some substantial points in his report. The problem is that for years the Government said that they were waiting for Lyons, but he now says, "Sorry, the time is not ripe." It is a pity that we have an outstandingly good intellectual thesis that has not rescued us from some of our immediate dilemmas in the way that some of us hoped it might have done.

David Curry: I am sure that that is the case. On top of that, the Government, for reasons that we understand, wish to restrain the increases in council tax. If we do not have capping, the threat of capping has done that job and that has been used by both parties. I welcome the movement to two-year funding, and longer-term funding is clearly a sensible way to go.
	There is a problem for this Government and there will be a problem for an incoming Government. I would not want my party to come to office and then spend ages agonising over the same fruitless search for the north-west passage, which is the way through local government finance, that has preoccupied so much of this Government's time and no doubt would have preoccupied previous Governments' time. The fact of the matter is that there is no north-west passage—that is the problem. There is no pathway through the ice that is blocking the way. The return of business rates is not a panacea, given that the money is not a new source of funding, but it represents a more devolutionary way of applying the tax that creates more initiative.
	We should explore the idea of establishing a neutral agency for the distribution of grant. Such agencies are increasingly coming into fashion in other sectors of the public services. While we should explore the idea, rather than necessarily endorse it, both parties have an interest in finding a settled way to deal with the matter.

Andrew Slaughter: During our debate on the future of local government, I thought that it might be helpful to consider a warning from history, albeit recent history. My local authority changed hands from Labour to the Conservatives just a year ago. I have suggested why that might have happened: partly through a deliberate deception—saying one thing and doing another—and partly owing to simply the absence of information. I do not remember seeing anything at all in the Conservative manifesto, which I have re-read, about the £34 million in cuts that the council is introducing across the board over the next few years. There are a few salutary lessons to be learned by anyone who is thinking about voting Conservative on 3 May, so I will run through one or two of them.
	The first thing that one gets is school closures of an especially perverse kind. Hurlingham and Chelsea school, which is a much loved and much improving school in Fulham, was told out of the blue last autumn that it would close. The council then set out to rubbish the school systematically by writing to prospective parents to tell them that they should not send their children there. The head teacher, who is a very mild-mannered man, wrote to the leader of the council last week to say:
	"the persistent misrepresentation of data has been a major fact in hiding the real context since your administration came to power".
	Despite marches and hundreds of representations, the council persisted with the closure.

Andrew Slaughter: Not at the moment.
	The fact that the council persisted with the closure meant that the matter had to go to the supposedly independent school organisation committee, but the council replaced members of that committee with people whom they thought would vote in its favour. However, the council's presentation to the committee was so lamentable that even the people whom it had deliberately put on to the committee could not vote for the proposal. As a result, the proposal should have gone to the independent adjudicator today, but yesterday the council withdrew its proposal for closure. Although it gave no reason for that whatsoever, the reason is clear: there was no basis for the closure except for the fact that the site was valuable and the council wished to sell it off for capital gain. Despite all the hurt and distress that has been caused to children, parents and teachers, the council has made no apology. It has instead said that it will set up an independent commission, which will be an ill-thought-out body with no remit, chaired by a Tory peeress.

Andrew Slaughter: It is surprising that I know more about what was said at a meeting that I did not attend than the hon. Gentleman does about a meeting that he did attend. The only point that was being made is that it was not necessary to make £34 million-worth of cuts to front-line services in order to achieve a very small council tax cut; efficiency savings could have been made, instead. I can tell him that I do not meet anyone in the borough who does not think that they have had a raw deal.
	I visited the council's website the other day, on which nine people had allegedly said that they supported the council tax cut. I queried that, because the letters looked rather staged, and I got this response from the borough's chief executive:
	"Of the nine views posted on the 'Share your Views' area on council tax, all but two came from a vox pop done by press office staff on the streets of the borough, so there are no 'original' letters...The first two entries on the site were from emails forwarded to the council from"—
	the letter then names the hon. Member for Hammersmith and Fulham (Mr. Hands). The letter continues:
	"At the time of posting, there were no other comments received".
	So it appears that nobody supports the hon. Gentleman's position in the borough, and I am not surprised.
	To return to my brief, the second thing that happens under a Tory council is cuts to the voluntary sector. I have a separate Adjournment debate on that subject on Monday, so I will not dwell on it, but the thick end of £1 million is being cut from voluntary sector organisations, which include one of the best law centres in the country, organisations that support older people who are trying to get back into work, and organisations that provide for the single homeless. Opposition Members have supported many of those organisations in the past, and have sat on their management committees, but now the funding for all those groups is being cut by the Tory council.
	Thirdly, I should mention social care. The hon. Member for Meriden (Mrs. Spelman), who spoke for the Opposition, shed crocodile tears on that subject, and I have alluded to the increase in charging that the Conservatives in Hammersmith and Fulham had promised not to introduce in their manifesto. Hammersmith and Fulham Action on Disability, one of the voluntary organisations under threat, said:
	"Before the election when seeking votes, Conservative councillors undertook to sustain the no charging policy—but now they have found a way to erode it."
	Some 1,400 people described as having moderate care needs are at risk of losing all home care services because of the changing criteria. Kevin Caulfield, the chair of the coalition against charging, said:
	"We expect our council to lead on policy and practice that improves the quality of life of older and disabled residents—not introduce policies with poor consultation that will only result in increased poverty and isolation."
	The fourth result of a Conservative council is increased charging that far outweighs any cut in taxation. There has been a 25 per cent. increase in meals on wheels charges and there is a £6 charge for refuse sacks for recycling. The borough does not meet its recycling targets, but it will now charge people for the sacks that they need in order to recycle. When challenged on that, the council said that people had been misusing the sacks. They had been keeping them at home and not using them, and the charge was the solution to that problem. The council is looking to increase parking charges by 50 per cent., to £2.40 an hour. It has increased burial charges by 52 per cent. and it has even proposed to charge school governors for the police checks made on them.
	The fifth result of a Conservative council is an end to social housing programmes across the borough. There is also a change in housing allocation policies, and families are now being put into one-bedroom flats. As for those who happen to be made homeless, the council has even cut the grant that provides for the storage of people's furniture while they are looking for another property, so that furniture has to go, and there is very little chance of getting it back. Sixthly, there are cuts relating to environmental policy. Almost £1 million has been cut from refuse and street cleaning services. I have mentioned recycling; today I received a letter from someone who had asked the council why they could not recycle their kitchen waste. The council's response was that Government regulations meant that it could not take that waste. The person found that perplexing, as they live only 50 yd from Ealing, which does recycle kitchen waste, but I have already alluded to the honesty with which the local authority acts.
	Seventhly, I notice that there is a reference to library services in the Opposition motion, but those services are not free from attack either. The mobile library and the housebound readers' service have gone. The main reference library is being closed, and its specialist book collections are being dispersed and sold off. The council is also phasing out qualified librarians, because it does not think that it needs them at all.
	Policing is the eighth thing that suffers. The previous Labour council invested in extra officers and safer neighbourhood teams. The Conservatives have promised—another promise—24/7 neighbourhood teams, but the first thing they have done is cut three additional officers, which represents a 25 per cent. cut, from Hammersmith Broadway, the ward with the highest crime in the borough that was the scene of a tragic murder only a month ago.
	I am not suggesting that all councils are like Hammersmith and Fulham, or that they are all quite as crackpot and doctrinaire in their behaviour. However, I make a plea to anyone who is thinking of voting for a Conservative council in May to heed the lessons of what the Conservatives do in office, rather than what they say they will do when they are trying to get into office. We have heard some erudite speeches about principles, but I suspect that when people go to vote on 3 May they will be most interested in whether their councils can provide reasonable taxation as well as the services that local communities demand. That is not being done—those services have been cynically cut in Hammersmith and Fulham—and it is a lesson that everyone should bear in mind.

Charles Hendry: The other thing people get with a Conservative council is a council that is re-elected with a bigger majority every time, because people are happy with the services that it provides.
	I want to focus on two issues: the raw deal that councils in East Sussex are getting under the Government's funding formula, and the erosion of powers that has prevented local councils from being able to make decisions on some of the most important issues that affect the people who live within their boundaries. First, there is a deep imbalance in funding for councils. I am often told that money is taken from the south-east and is given to Labour's marginal seats in the north, and there is clear evidence of that imbalance. We now have the facts. Of East Sussex councils, Wealden has the highest proportion of elderly people—certainly of the over-80s and over-85s in the country—and that is partly why we have roughly the third lowest gross domestic product in the country. However, the grant per head that Wealden receives from the Government comes in at £54.03. The maximum level in the country is £133 per head, and even the average is £92 per head. If Wealden were funded at the average level for district councils, it would have a further £5.5 million a year that it could spend on local services or use to reduce council tax. It would increase its grant level by well over half.
	Another way of looking at it is to consider the proportion of council spending that has to come from council tax. If we look at the country overall, the average is 46.1 per cent., but the lowest proportion is in Exeter, where it is 21.6 per cent.—I am not sure what Exeter has done to be so special, apart from being a marginal seat—but in Wealden, it is 63 per cent. That is why council tax has been driven up so much: my councils do not receive the same level of grant as other authorities.

Bob Neill: Time is very short. I hope that the hon. Gentleman will forgive me if I make a little progress.
	One of the reasons why people do not get involved in local government or vote at local council elections is the belief that local government has very little discretion. That has been made worse under the current financing regime by the extent of ring-fencing. The evidence demonstrates that about 50 per cent. of the funds that come from the centre to local government is ring-fenced. Back in 1997-98 that was 4.5 per cent. Steps could be taken immediately to reduce the amount of ring-fencing, in the same way as we should be reducing, as has already been said, the level of controls and the targets culture, which impose a considerable burden.
	I would go further. I take the view, as my right hon. Friend the Member for Skipton and Ripon said, that the time has come when we should consider, with certain safeguards, returning the business rate to local authorities, not least because there is a need to encourage them to broaden their tax base. When I was a local councillor, there was almost some positive competition among London boroughs to encourage business to have more commercial development in the local authority because we gained benefit to our tax base. It would be healthy for us to look at that once again. In the same way, if we follow that localist path, perhaps we must accept that we should think again about capping.
	Those are the big points that we need to look at, and a lot more work needs to be done on that. I come now to a specific point—

Andrew Pelling: I will keep my comments short as I know that another Back-Bench Member wishes to speak.
	The upcoming local elections represent the 25th anniversary of my holding elective office, most of which has been in local government. But perhaps the debate has not changed very much during those years. In many ways, I wonder whether the Lyons report will end up adding much more than the Layfield report did in terms of changing local government finance.
	In many ways, much of this debate could have been repeated 25 years ago, and I am not sure whether we add much to debate when we get involved in ritual condemnatory remarks about one particular local authority or another.  [Interruption.] I do wonder whether the hon. Member for Ealing, Acton and Shepherd's Bush (Mr. Slaughter), who speaks so often about Hammersmith and Fulham, ever debates any other subject in the Chamber.

Andrew Pelling: I shall speak for only a very short time.
	Such is the diffusion of power away from local government that there is little value in trying to pin blame on one local authority or another in terms of performance, bearing in mind the way in which so few powers are given to local government in any case.
	It is welcome that the number of targets for local authorities have been reduced from 1,200 to 200, but that is still far too high a number if we are to believe that there is real discretion for local authorities.
	There must come a time for some change in local government finance. With all the nationalisation that has taken place in local government provision, the quick and dirty approach will be to take much of those funding flows that in reality are national expenditures and to leave far more of the overall budget left for local authorities in the control of local authorities so that there will be much greater accountability.

Eric Pickles: We have had a good debate that has ranged widely from reorganisation to ring-fencing. We heard a particularly elegant speech by my right hon. Friend the Member for Skipton and Ripon (Mr. Curry) about the balance between capacity and accountability. I seek some clarification from the Minister on the "à la carte" nature of the restructuring.
	The Government are conducting a review of local government in several English counties, but I am not clear as to what authority they have to do that. Last Wednesday in a Westminster Hall debate, I had an opportunity to ask the Under-Secretary, the hon. Member for Basildon (Angela E. Smith), that very question. I said:
	"I have a simple question. What powers is the Minister relying on to make these deliberations?"
	She replied:
	"Powers in the Local Government and Public Involvement in Health Bill that is going through Parliament."—[ Official Report, Westminster Hall, 18 April 2007; Vol. 459, c. 94WH.]
	She then suggested that I was well aware of that.
	I believed that procedures already existed to change the structure of local government. Indeed, they do. The authority for annual review of local government is set out in the Local Government Act 1992. Section 13 states that the Secretary of State may request the Electoral Commission to undertake a review, which in this context means,
	"the replacement in any non-metropolitan area, of the two principal tiers of local government in a single-tier".
	Section 17(1) states that structural changes can be effected by order of the Secretary of State on the recommendations of the Electoral Commission. In the case that we are considering, no request has been made to the Electoral Commission and, consequently, no recommendation to consider the structural changes.
	I am not aware of any other powers that the Secretary of State has to initiate such a massive task. I know that, after the Budget, we passed special resolutions that any change in tax, rates or duties would have immediate effect. I cannot recall the House passing any special resolutions to enable the Secretary of State to introduce the review. I am confident that the Under-Secretary would have mentioned them had that been the case.
	We are not considering an academic question, because local authorities have spent hundreds of thousands—perhaps millions—of pounds preparing for the review. They are responsible to their residents, who will look to them for the authority for expending that money. To have lawful authority, both Houses of Parliament and Her Majesty must agree. A draft law and a law in progress is not enough. Will the Minister for Local Government clearly set out the authority so that we can all understand it?
	I am delighted to see the Secretary of State in her place. She suggested that she sought to pull back the powers to restructure. I respectfully remind her that the Local Government and Public Involvement in Health Bill has not returned to the House. Is she giving an undertaking to table an amendment on Report?

Eric Pickles: Oh, I did—I always found that my hon. Friend delivered.
	My hon. Friend the Member for Croydon, Central (Mr. Pelling) spoke about greater accountability and wondered whether Lyons and Lichfield would end up as the same thing. At least there is a possibility of a BBC documentary about the Lyons report.
	The hon. Member for Leicester, South (Sir Peter Soulsby) asked what evidence we had that revaluation would increase the council tax. The answer is Wales, where 33 per cent. of households went up a band and only 8 per cent. went down. He criticised the suggestion that the local authorities have become the agents of Government, but the right hon. Member for Norwich, South (Mr. Clarke) originally made it. If the hon. Gentleman has problems with that, he should take it up with his party.
	The hon. Member for Hazel Grove was a little disingenuous. At least his predecessor admitted that the redistribution effect of equalisation—having a slightly higher local income tax in one part of the country to pay for another—could be a problem. The hon. Gentleman appeared to suggest that that was not the case. With only a week to go before the local elections, I thank him for making it clear that the Liberal Democrats oppose offering special help to pensioners. I will ensure that that appears in our last-minute leaflets to make it clear that the Liberal Democrats have abandoned elderly people.
	The hon. Member for North Swindon (Mr. Wills) was very kind about Conservative control in his area, suggesting that everything was right in respect of ring-fencing and central control, but his argument was eloquently demolished by my hon. Friend the Member for Bromley and Chislehurst (Robert Neill).
	The hon. Member for Plymouth, Devonport (Alison Seabeck) was too nice about me for me to criticise a single thing that she said, but I have to say to the hon. Member for Ealing, Acton and Shepherd's Bush (Mr. Slaughter) that every time he speaks about Hammersmith council I know exactly what the wedding guests felt like in "The Rime of the Ancient Mariner".
	The Secretary of State made an interesting point but was rather unkind about Trafford. I took the opportunity to look into all the metropolitan district councils surrounding Trafford—and guess which authority had the lowest council tax? [Hon. Members: "Trafford."] Yes, Trafford, and guess which party controls Trafford? [Hon. Members: "The Conservatives."] Yes, and all the others have levied vastly higher counciltax bills.
	The Secretary of State went on at some length about all the questions that we have been asking, suggesting that we were scaremongering about a new way of raising council tax and revaluation. Indeed, the Minister for Local Government got rather upset about it all. Yes, we have tabled a number of parliamentary questions and we have taken the opportunity to use freedom of information legislation. We know that the Government are looking into computer-assisted mass appraisal and automated valuation models and that they have spent the best part of £500,000 buying in bulk cameras for their inspectors to have a look at various things.
	We also know—the House may be interested in this—that the council tax inspectors in the Valuation Office Agency have been holding high-level talks with local tax inspectors in Hong Kong. That gives a whole new dimension to a Chinese takeaway. The talks included a summit at Hong Kong's new Disney resort on the logistics of holding annual council tax revaluations.
	As my hon. Friends will testify, I have always been of a romantic disposition, dreaming in my youth of far and distant places. In my early years, I was much taken with the book, "Beau Geste" and felt that to see the world, a period of recruitment in the French foreign legion was the thing to do. I see now that I was wrong and that the Valuation Office Agency is the place for exotic travel, taking in Disneyworld and Hong Kong. Admittedly, unlike in the foreign legion, one is unlikely in the Valuation Office Agency to be shot at by Tuaregs or the Vietcong, but there are other discomforts. The air conditioning in some of the five-star hotels can be a little tricky after one has spent the day talking to Mickey Mouse. There is surely no distance that the Government will fail to travel in order to rob pensioners of their savings.
	There is one sure test that shows how proud Government supporters are and how much they want to win in May. Are they prepared to be associated with Labour policies? Are they prepared to put their names on the ballot paper? Are they prepared to wear the party's colours? We all know where the Conservative party stands. We are standing over a record number of seats—90 per cent. of all the contests have a Conservative party candidate standing, and it is even higher in some regions. The Liberal Democrats are just treading water, but the Labour party has gone backwards, contesting not far short of half the seats in the election. That is the lowest number of seats contested by any Government party at a local election. It is the clearest indication that no one trusts this Government. Nobody believes that their policies are working and their closest supporters are too ashamed of Labour's record in local government to wear a red rosette.

Phil Woolas: I congratulate the hon. Member for Brentwood and Ongar (Mr. Pickles) on the flourish at the end, which has done for local government policy what George Best did for the soft drinks industry—not much at all. I congratulate him on the flourish, but what is clear from the debate is that the traditional stance of the Conservatives in opposition is not to have a policy. We know that they do not have a policy, because they have not said anything positive in debates over the last two years. We know that it is the job of Her Majesty's loyal Opposition to oppose Government policy, and we expect them to do that, but if I were Her Majesty, I would want my money back, because they have failed to do it effectively.
	The Conservatives are not stopping at opposing our policy, however. They are engaging in a rather dangerous and disingenuous campaign of misrepresenting the Government's policy. They are misrepresenting the Government's policy, and they know that they are doing so. The comments made by the Government in debates in Committee on the Local Government and Public Involvement in Health Bill—which my hon. Friend the Member for Plymouth, Devonport (Alison Seabeck) rightly observed was a consensual Bill—have not been passed to the Conservative Front-Bench spokespersons who have been speaking tonight.
	On restructuring, the Government asked councils whether they wanted to put forward proposals to move to unitary structures. It has already been pointed out that half the councils that have put forward proposals are controlled by the Conservatives. These are not proposals from the Government. They are the result of a devolutionary approach to restructuring, which stands in stark contrast to the approach taken by the previous Conservative Government, who imposed unitaries on Scotland and Wales without so much as a proper consultation, and who introduced changes following the Banham review, after a helicopter flight by the then Secretary of State, Michael Heseltine, with an Ordnance Survey map and a felt tip pen—his words, not mine. The idea that the Government are putting a gun to the head of councils and threatening to withdraw resources is a scandalous accusation, and it is not true. I understand that there are local elections going on, but I wish that the Conservative party would keep the arguments at local level and not pretend that the proposals are those of the Government.
	The power to direct has been agreed with the Conservative-led Local Government Association on a cross-party consensual basis. The commitment has been given to the Committee considering the Local Government and Public Involvement in Health Bill and to the House by the Secretary of State that that will be the case, yet the myth that it is not the case is perpetuated.
	The revaluation issue is the entirety of the Conservatives' policy. Again, it is based on what is frankly a misrepresentation, and they know it. They say that the Government are proposing new powers for inspectors; we are not. The powers of inspection were laid out in 1991 by the then Conservative Government who introduced the council tax. The law does not allow an inspector to enter someone's home without the permission of the householder. There are no plans to change that, and the Conservatives know it.
	The Conservatives no longer have a policy to engage in a constructive debate about the future of local government. Instead, they opportunistically attack the Government on the basis of misrepresentations. At least the right hon. Member for Skipton and Ripon (Mr. Curry) took us into a proper policy debate, because he understands local government finance in a way that I suspect some of his colleagues do not.
	I shall apply myself in a moment to some of the serious policy points that have been made, but before I move off my criticism of the Conservatives' attack, their strategy and their tactics, let me issue a warning to them. It is a warning that was sounded by my hon. Friend the Member for Ealing, Acton and Shepherd's Bush (Mr. Slaughter). In the 1980s, the Thatcherite councils in Wandsworth and Westminster were seen as flagships—

Phil Woolas: No, I will not.
	The accusation repeated tonight that the Government distribute formula grant on the basis of party political bias is scurrilous and a misrepresentation. It is not backed up by the facts, by the figures provided independently by the House of Commons Library, or by the Local Government Association's policy. I give the warning about the U-boat of the Conservative party at local level, because millions of voters on 3 May will look to Hammersmith and Fulham council for an example of what would happen were they to be taken in by the scaremongering of the Conservative party and its supporters in the press.
	At least the hon. Member for Hazel Grove (Andrew Stunell) has a policy that we can debate. I disagree with that policy, as local income taxes, as my hon. Friend the Member for North Swindon (Mr. Wills) said, would require a redistributive amount that would diminish the local discretion sought. The idea of localisation of business rates ignores the reality of the direct support grant, the changes made in the past 10 years and the £1 billion extra provided through the local authority business growth initiative scheme, which is welcomed by councils across the political spectrum.
	The Liberal Democrats claim that their policies are original and sound, but the problem, as a predecessor said, is that when they are original they are not sound, and when they are sound they are not original.  [Interruption.] It might be old but it is still true; at least the hon. Member for Hazel Grove knows the origin of the quote, which is more than can be said for some other Opposition Members, who should know it.
	My hon. Friend the Member for Plymouth, Devonport, as chair of the all-party local government group, made a thoughtful speech. She praised the direction of travel through local area agreements and the duties to co-operate in the Local Government and Public Involvement in Health Bill.
	My hon. Friend the Member for Leicester, South (Sir Peter Soulsby), who brings huge experience to the debate, said that he welcomed the direction of travel and would like to go further.
	The hon. Member for Croydon, Central (Mr. Pelling) spoke on behalf of his council and made some important policy points, as did the hon. Member for Bromley and Chislehurst (Robert Neill). We have debated previously the distribution of grants and how that affects his area.
	My hon. Friend the Member for North Swindon brought to our attention some important points about what has been happening in Swindon. I give him the assurance that he requested: the improvement that has taken place in Swindon council has in significant part been as a result of the strategy of council improvement backed up by real money from central Government. I hope to make that point in Swindon next week.
	The hon. Member for Mole Valley (Sir Paul Beresford) gave me some good advice on twisting the Liberal Democrat graph, and I shall examine his points. I disagree with him, however, on his criticisms of local area agreements. There is broad and deep consensus for the idea of joining up funding at local level, and of changing the performance regime. The Government have put huge extra resources into local councils, which have seen improvements in services, and are creating a regime of devolution.

Question accordingly agreed to.
	Madam Deputy Speaker  forthwith declared the main Question , as amended, to be agreed to.
	 Resolved,
	That this House notes the transformation in local government since 1997 and the dramatic improvements in performance across a wide range of front-line services; recognises the achievements of local authorities and their staff with a record number of authorities awarded three or four stars for their performance by the Audit Commission in 2006; contrasts this with the underinvestment and poor morale that the Government inherited in 1997; applauds the Government's radical and devolutionary local government White Paper as the next stage in the reform of local public services, strengthening local leadership and partnership working and empowering local communities; believes that the measures set out in the Local Government and Public Involvement in Health Bill will strongly promote sustainable communities, improving local environmental quality and the quality of life of local residents; congratulates the Government on the way in which it is providing stable funding for local government, increasing overall grants to councils by39 per cent. in real terms since 1997 with the average council tax increase in England at 4.2 per cent. for 2007-08; and therefore supports the Government in implementing the White Paper and the Bill.

Ian Gibson: It is a pleasure to talk tonight about plant science and climate change because, in some ways, climate change has become the media story of the decade. Although there is a tendency to overblow some of the claims of what might happen, most of us accept that things will happen and that they are beginning to happen. I want to address that.
	We see the effects of climate change all around us. In a funny way, I often think about Vivaldi's "Four Seasons", which could become three seasons. That would be quite a revolutionary change in classical music. We look at the papers and see reports of snow-less ski slopes and flowers blooming at all the wrong time throughout the winter. That is not something that just happens on the equator or elsewhere; it actually happens in this country as well.
	When it comes to combating climate change, things are not as simple as they appear. Research recently and a great deal of column space has been devoted to talk about air travel, carbon emissions and carbon offset schemes. People argue scientifically that some of those schemes might not do what it appears that they would do. Recent research from the Lawrence Livermore laboratory in the United States and the Carnegie Institution at Stanford university in California suggests that planting trees to offset carbon emissions could contribute to global warming unless the trees are planted in the tropics. That is an interesting new aspect that we had not thought about. It is only research and more needs to be done, so I guess that what I am saying is that there are no quick fixes when it comes to climate change, but we have to adopt and develop the policy of planting trees, whether they are in the tropics or elsewhere.
	The rule of no quick fixes also applies to the first generation of biofuels. Although the need for zero-carbon fuels is obviously real and present, the deforestation of developing countries taking place in the rush to make way for biofuel plantations is having a more severe effect on the planet than many of us imagined. It is argued that the carbon emitted by burning the trees and the peat to make way for biofuel crops far exceeds any savings that one could hope to make from burning renewable fuel instead of petrol. A further side effect is the destruction of many natural habitats and ecosystems as developing countries struggle to get into the new market, effectively throwing environmental concerns to the wind. Interesting questions in this area still need to be resolved, despite the fact that we acknowledge that climate change is taking place.
	If we look at this complex issue closely, we find that our mission is to consider not only how to prevent global warming, but how to deal practically with its consequences in the United Kingdom. We must ensure that we enter the 21st century with secure energy and food supplies. If we are to find the solution, we must examine the science that is being developed with plants in this country. We cannot look abroad for the solutions to our energy problems. We should be implementing schemes that will enable us to be responsible for what happens in the UK by concentrating our efforts on a second generation of bioenergy crops that use biomass.
	Biomass in itself is just a source of energy production along with other renewable energy sources, such as wind, wave, geothermal and sunlight. Miscanthus, switch grasses and willow and poplar trees can all be grown in the UK to contribute to the biomass initiative. Their growth requires less land than existing biofuel crops. They are renewable and carbon-neutral. They do not require the volume of chemicals and pesticides that have led to the criticism of crops such as rapeseed.
	Short-rotation coppice willow is being grown at Rothamsted Research. The crops grow on marginal land of low quality and require little input. If such second-generation bioenergy crops were grown on 350,000 acres of UK land and processed to produce fuels such as diesel, some 7 per cent. of the UK's petrochemical needs would be met without reducing food production and with very little input. While such plant development is important, we need more research. It is welcome that the Biotechnology and Biological Sciences Research Council has put £20 million into that research.
	We face a situation in which before the research has been done, many countries and companies are planting vast areas of biofuels. I argue that that will damage the environment. If we are able to produce more bioenergy crops in the UK, we will be able to control the way in which they are farmed and regulate the carbon dioxide that is emitted. We could reduce the carbon dioxide emitted by the transportation of imports. In that way, we would guarantee our energy security, which is a real problem that relates to the sources of our energy production.
	It is almost certain that there will be competition for farmland between biofuel companies and the food industry. Our main concerns will be reducing carbon emissions and ensuring that we have effective farming systems. Bioscience offers us the possible solutions that we need.
	As the climate warms, it will be almost inevitable that we will witness further physical changes to the UK countryside. That will have a massive effect on farming in this country. Arable farmers will need crops that can grow and be harvested under variable temperatures and rainfall. For example, it is predicted that the average temperature in East Anglia will have risen by 3° C by 2050. It is no use George Bush telling us that we will reduce global warming by talking in terms not of Fahrenheit, but of Celsius, even though the numbers are obviously reduced. There will also be greatly reduced rainfall and much more water evaporation and carbon dioxide in the atmosphere.
	The climate can affect the length of a harvest and soil structure, which vary massively even from year to year. Owing to global warming, farmers will face new infections and parasites. Wetter winters will make cereal crops more prone to fungal diseases such as Fusarium ear blight. We will simply not be able continue to grow the variety of crops that are traditionally grown in the UK.
	There are a number of ways to approach the problem. The rising temperatures will lead to a lot of drought, and in East Anglia, yields of sugar beet are expected to decline by half in areas that are already experiencing those difficulties. We can increase rainwater catchments, and irrigation efficiency; those are practical starting points, but we must also look into the genetic make-up of plants that can survive in extreme climates. We are really gifted at such work in this country; we have centres such as Broom's Barn, Rothamsted and the John Innes Centre in Norwich, which are tackling the problems of developing drought-resistant sugar beet. We can now isolate the genes that allow plants to cope with extreme temperatures. Those genes can also be bred into commercial crop varieties.
	We can protect cereal crops from fungal diseases by introducing genes with a natural resistance. Scientists at the John Innes Centre in Norwich have isolated several genes that decide whether a plant needs a cold period before it will flower. The traditional teaching is that there has to be a cold period before an explosion of flowers will appear. There is a cold trigger that can be bred in and out of plants to produce winter and spring varieties, and it varies; that occurs in plants in Spain, Sweden and in this country, and we are learning how that happens. That technology will become really important as temperature changes take place. Crop protection is another important subject to consider. All our farmers, including organic growers, rely on plant protection products of some kind. As biofuels and food compete for land, we will only meet the increasing demand for both if we ensure that more crops make it to the harvest stage, through the responsible use of pesticides and effective land management.
	Plant science has a central role to play in all our futures, and in combating climate change, and we miss its importance at our peril. It is sad that job losses are occurring in places such as Rothamsted, which had a net reduction of 17 members of staff in 2005-06. The John Innes Centre is absolutely world-class—the best in Europe—and it produces research that everybody admires; I mentioned just some of it—the research about flowering and the genes involved in it. I not just talking about genes that make better-looking plants, but genes that are commercially important.
	How long will we be at the forefront of plant science if we do not make the necessary investment and address the fact that people are not entering the profession? Many young people do not see that plant science is really quite an appetising profession. We have to link up that kind of science with innovation and public benefit. As you will know, Mr. Speaker, I am also actively interested in biomedical sciences and biomedical research, for which a plethora of research and development funding has been made available by the Government, charities and the pharmaceutical industry. We may bemoan the conditions that those sciences face, but they are nothing like as bad as the what is happening in the plant sciences. There is one research council involved in plant sciences, the Biotechnology and Biological Sciences Research Council, and only one charity involved in plant science, the Gatsby Charitable Foundation, which was set up by the former Minister for Science and Innovation, Lord Sainsbury of Turville.
	We have to acknowledge that the plant-breeding industry in this country has been affected by the genetically modified crops debacle and the "anti" attitude of the public. In the House, too, people were against GM crops and fought against them, and that has caused people in the industry to leave the UK and go elsewhere to develop their talents and the new sciences. We get £336 million in funding a year, but a glance at the title of the Biotechnology and Biological Sciences Research Council—the body that gets that kind of money—shows that it has many other areas on which to spend that money, including biotechnology, another area that has a world-class dimension to it. Plant science always falls down the list of priorities.
	It is important to establish the industry in this country. BP is setting up a $250 billion biofuels research centre in California, rather than in the UK. That is really strange to me, given the scientific expertise that we have. It was Schwarzenegger himself who agreed to match the investment, while the research council could offer only £20 million. It is sad that that has developed in the states, as it could have developed here.
	While the UK has very good plant-breeding technology, our ability to use that knowledge is extremely vulnerable. It is regarded as underfunded and unsexy, in fact, by many young scientists, and I have attended many meetings at which young people have said they do not want to go into plant research, because there is no money or career structure. We need to develop plant varieties that are specific to the UK's climatic and social needs. The multinational plant-breeding companies are willing to do so, and it will help us with our food and fuel security, but we must make them regard it as a priority to be developed in the UK with the backing of our proud and talented researchers.
	The Government, too, must start to think about plant sciences and practical solutions to climate change that they can develop to provide energy, resistance to diseases and so on. Things are going to change, and we cannot wait 20 years. We must accept that it is going to happen. Malaria is likely to come to this country, but many plant diseases will come here, too, and we should research them now. We have to get the agricultural community behind us, and they are a conservative, resistant lot. We must not scare the pants off them, but we must make them acknowledge the fact that there is a serious problem.
	Climate change is an extremely important issue for the Government, and a great deal has been said about that. We have introduced a draft Climate Change Bill, which we are very keen on, and which we want to develop. The leader of the Opposition wears organic trainers, whatever that means, but despite all that, plant sciences have had a bad deal. Although stem cell research is the front-runner, plant sciences have as much to offer in tackling climate change as anything else, so I am very pleased to present this debate.

Barry Gardiner: It is always a pleasure to respond to a debate introduced by my hon. Friend the Member for Norwich, North (Dr. Gibson), because he has an unparalleled knowledge of science in the House, having chaired the Select Committee on Science and Technology. His scientific background, too, stands him in tremendously good stead. This evening, he spoke about many things including, first, the need to plant trees, as well as biofuels and the danger of monoculture. I hope that he agrees that peat bog remediation is every bit as important as the need to plant trees. I was on the top of Blackmoor in the Peak district at the weekend looking at the depletion in the peat. The peat bogs in this country represent a greater sequestion of carbon than the entire forests of France and the UK combined. They are infinitely more powerful, and they store carbon for thousands of years, rather than just for hundreds of years, as standing forests do.
	My hon. Friend spoke about the dangers of biofuels, particularly of monoculture. Bioethanol can be a very good biofuel if it is used instead of petrol, but it is not so good if, to produce it, we destroy virgin rainforest, and I absolutely agree with the point that he made. I wanted to pick up one more initial point in his contribution, and echo his praise both for the talented researchers in this country and for their work on plant science and in other scientific areas. That is certainly an industry that will come more and more to the fore as we face up to the problems of climate change.
	Agriculture as a whole contributes 7 per cent. of all UK greenhouse gas emissions and 14 per cent. globally. About 36 per cent. of the UK's total methane emissions and 67 per cent. of nitrous oxide emissions come from agriculture—for example, from artificial fertiliser, manure and livestock. Although agriculture is only directly responsible for around 1 per cent. of UK carbon dioxide emissions, the sector can help to mitigate CO2 emissions from other sources through carbon sequestration in soils, as we have mentioned, and timber, and by producing energy crops to replace fossil fuels.
	On 13 March this year we published the draft Climate Change Bill for consultation and pre-legislative scrutiny. The Bill would make the UK the first country to set a long-term legal framework for reducing emissions over the next 45 years and beyond. Although the draft Bill focuses on carbon dioxide, which is not the most significant greenhouse gas for agriculture, the independent committee on climate change, which the Bill establishes, will have a duty to advise the Government in relation to other greenhouse gases whenever the Government asks it to do so.
	Agriculture is central to helping us meet our objectives on climate change, and is significant in the UK's climate change programme. Farmers growing crops or rearing livestock on grassland will feel the impacts of our changing climate very directly, and they need to be ready to adapt to these impacts. All farmers have a major role to play—for example, by reducing their direct greenhouse gas emissions, managing the land in ways which help sequester carbon, and supplying bioenergy crops as an alternative to fossil fuels.
	DEFRA's agriculture and climate change research and development programme, which is worth around £5.6 million in this financial year, helps build understanding and evidence about the threats and opportunities that climate change presents, and about what farmers can do to reduce emissions. It includes research on climate change mitigation in agriculture, the impacts of climate change on farming, including both livestock and arable sectors, and the vulnerability of UK agriculture to extreme weather events, about which my hon. Friend spoke. This is within the 2007-08 DEFRA budget of £70 million for sustainable farming and food science, including animal health and welfare.
	Specifically in relation to plant science, our research and development programme is looking, for example, at the vulnerability of crops to extreme weather events, which are expected to increase with climate change; at the long-term plant breeding challenges faced by the plant breeding sector; at how to develop crops for energy that will support our climate change and renewable energy targets, at a price which is competitive in the market for renewable energy; at how to increase commercial yields of biomass crops; and at how to determine and demonstrate the most economical systems for growing biomass crops, consistent with the protection of the environment and, of course, with minimal use of pesticides and fertilisers.
	The direct effects of climate change on crops has been well researched in DEFRA research and development. Further research is being commissioned to build on this. Current considerations suggest that climate change impacts do not threaten the viability of UK agriculture as a whole, but particular regions and individual farm businesses need to be aware of both the risks and the opportunities. In decades to come the impacts of climate change will be more defined, with winter rain becoming more sporadic and intense, and summer rain more scarce.
	Crop yields are affected by many factors associated with climate change, including temperature, rainfall, carbon dioxide concentration in the atmosphere, extreme weather events and climate variability. Models developed through the research that the Biotechnology and Biological Science Research Council and DEFRA have funded on plant science and crop development are producing predictions based on possible climate scenarios. These can be updated as more reliable models of climate change become available.
	Potential threats from climate change to farmers growing crops include prolonged and more frequent droughts, changes in rainfall distribution, increased risk of new crop diseases or some pests becoming more serious, and increased vulnerability of crops to variable or extreme temperatures. Soils are also likely to be affected by variation in temperature and rainfall. Some soils are likely to form impenetrable caps, increasing the risk of run-off and subsequent pollution events and flooding. Cracking in soils after dry periods may prevent rainfall from being retained and further increase subsequent droughts. Hotter, drier summers may also affect subsoils and make it more difficult for plant roots to penetrate and grow.
	On the other hand, rising temperatures and longer growing seasons will provide opportunities for farmers to grow new crops, such as energy crops, and supply new markets. For some commodities, the UK could have an advantage compared with traditional competitors. As the climate changes, some crops will become easier to grow and others harder. Landscape features may also change—for example where crops grown for fuel replace those grown for food or set-aside.
	We have a continuing programme of research looking at the contribution of different land management practices to climate change objectives—both adaptation and mitigation. Through previous work, which has been published, the UK is well served with information on impacts.
	We need to work with farmers and land managers, and with organisations such as the Rural Climate Change Forum, to ensure that farmers have the information and advice they need to turn the results from climate change research into practical action to reduce greenhouse gas emissions, as well as to adapt to these impacts and make the most of new opportunities.
	Basic plant science in the UK is funded by BBSRC rather than DEFRA. The BBSRC investment includes a large proportion of the £30 million per annum spent at its research institutes—Rothamsted, the John Innes Institute in Norwich and the Institute of Grassland and Environmental Research, and there are also many projects funded at universities related to plant science. Much of that research investigates the fundamental processes in the life of plants that climate change is likely to affect. By understanding how these responses work and linking them to the genes involved in well studied "model" plant species, scientists and subsequently commercial plant breeders will be able to breed characteristics into crops to help them tolerate and continue to grow under more extreme conditions.
	In addition to DEFRA's specific agriculture and climate change research, the UK spends about £5 million annually on research and development connected with the genetic improvement of UK grown crops. This will underpin the development of crop varieties better suited to future climates and new crops and markets. The DEFRA research links with a specific BBSRC crop science initiative, which seeks to apply results from fundamental plant science to crops. These together form a basis for collaborative work with industry—with plant breeders and farming organisations.
	For major field crops, including wheat, oilseed rape, biomass, pulse crops and oats we have invested in resources and techniques to underpin plant breeding by creating crop genetic improvement networks that focus on traits that will help commercial breeders introduce varieties that can improve the environmental footprint of production systems or help to address the likely stresses on crop plants from climate change. Similar projects are in place for grass and forage and some horticultural crops.
	The oilseeds genetic improvement network—OREGIN—provides an example of the collaborative work in progress. Researchers based at Rothamsted, the John Innes Institute, Warwick university and elsewhere are all involved. Since it was established in 2003 it has provided a focus for the research and stakeholder communities associated with oilseed rape and brassica crops. The project has provided reference and experimental material and built expertise as a basis for studying aspects that may be affected by changing temperature, such as oil profiles and risks from attack of pests and pathogens, and the more efficient use of inputs, such as nitrogen fertiliser.
	Scientists in our leading institutes are therefore working, often in collaboration with others, to understand and model how crops will perform under a range of future possible climate scenarios. They are also working in conjunction with others to develop crops that are currently well adapted to the UK or have potential here so that they remain productive as the climate changes.
	The threat of increased summer drought to crops and water availability for irrigated high value crops in eastern England is of particular concern. Research commissioned by DEFRA is looking at the volume of water used by farmers and growers to irrigate crops and its impact on water resources. This will include work to develop more efficient ways of using water in the light of future climate change.
	Climate change and increasing global trade also bring additional risks from pests and diseases to which current crop varieties may be more susceptible. Improved genetic resistance to threats that could become more serious will prevent future damage and losses without the need for additional pesticide applications.
	As winters become warmer and wetter, conditions are likely to improve for certain crop pathogen species. Some pathogens such as species of Fusarium that cause ear blight in cereals are not yet major problems in the UK. These may become an increasing risk, especially if conditions also favour the production of grain maize, which is an alternative host. These fungi are associated with the production of mycotoxins in grain, which presents a health risk to humans and to animals.
	Besides concerns about predicted changes to some pests that may become more serious, there are also concerns that organisms of conservation found in farmed environments may in contrast become rarer, and the need to devise sustainable conservation strategies, for example, in conjunction with agri-environmental schemes, will be greater.

Ian Gibson: Among all this activity that has gone on, does my hon. Friend think that the agricultural industry knows about it, or does it go on without its knowledge, or even interest?

Barry Gardiner: My hon. Friend characterised farmers who were "conservative"—I am sure that he used that word adjectivally with a small "c" rather than to denote any political association. In fact, I have been pleasantly surprised by farmers' willingness to see themselves increasingly as land managers, landscape managers and environmental managers who are prepared to get their remuneration not from the subsidies for production that we used to, and in some cases still do, pay as a result of the cap, but as a result of the public goods that they are creating. They are increasingly ahead of those in many places in the rest of Europe in appreciating their role to that effect—
	 The motion having been made after Ten o'clock, and the debate having continued for half an hour, Mr. Speaker  adjourned the House without Question put, pursuant to the Standing Order.
	 Adjourned at four minutes to Eleven o'clock.